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APPLICATIOr. FOR CONSTRUCT►.�1N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET + EVEREjT, yyp 98201 • 259-BB10 <br />� <br />C] DEMOLITION �COMBINATION fl BUILDIyG fl MECHANICAL f� PLUMBING fl SIGN <br />� <br />PROJECTADDRESS nz�Y �-���� �� t <br />�uJv.Q�o�C � ;yh n,.. ,.i <br />s�J <br />ANCWTECTOHOESIGNER MNtA0DRE55 . � ��;,r. <br />GTY 21P PNONE ' . <br />PWMBWGCONTqACTOR MqLA0DPE55 CITY � �. ..'.. .' ' I . <br />11P PHONE STAl. L�CENSE � � <br />CONTRACT PRICE OF WOflg . � •. .. . i �. , <br />��� �o�`' HEATIWG SYSTEM fl GqS fl ELECTRIC f-1 <br />DESCRIBE'�AND aE FOOT�GE I Vt{ OLVED <br />�.�_2 s-fzs�Lv CO�^CTPERSONANDPIIO�ENO. <br />�� . . <br />J��/ .tu��oes a�n7on f-PqOPERTY�SHOWNBELOW( <br />` LOT' L BLOCK pp_ <br />Pj, � �� ��! P� <br />y <br />P�y ELTA%1.0 MIMBEH <br />C�/1 D� DZZSLx/- !-� <br />CONSTpUC7�ON LOAry �ENUEq, ApppE55, TEIEPNONE <br />PLUAABINO <br />NO. TYPE OF FIXTURE OR ITE <br />WATER CLOSET (TOILE <br />BATHTUB <br />LAVATORY (WA;iH BASIN) <br />SHOWER <br />KITCHEN SINK 3 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAH. Frr, i <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONi SETBRCN REM SETB�CK <br />����� � <br />USEZON� V� IOTA f� <br />__ `� <br />MEIGIIT LIMIiATION NO OF DWELIING <br />7Q � IINI�S <br />�CJ <br />REO'0 <br />BY <br />FEE <br />S�� �7 i� X% � 7 � U. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED W�TH WHETHER SPECIFIED HEREIN OR <br />AUTH R T6 TO TVIOLq EAOR RCAINCELE THE PROy S Oh OF ANY <br />OTHER STATE OR LOCAL LAyy RE�ULqTINO CAN3TRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOq�ZED BY THE <br />OWNER OF THIS PROpERTY 70 PERFOpM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br />CONTRACTORS LAW 1827 RCW AND 298200 WqC. <br />SIGNATURE v �,Z$ //� <br />TE <br />Clry BUSINESS LICENSE NO. <br />NO. TYpE OF EQUIPI�ENT FEE <br />FORCED AIR SYSTEMS — B.TU M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHE& DRYERS <br />VENTILqTION FAN <br />RANGEHOOD <br />WATER HEATER . — <br />GAS FIREPL <br />GAS RANGE <br />GAS PIPING <br />EXHAUST Fl <br />SIOE SET�•R. � I PIAN <br />VACANI SITE <br />IIYES li NO <br />�� <br />)F BLWRI <br />4 SF Liv,HV t <br />! SF �iA.fp4� <br />BRSEMENT � � <br />IIYES I✓FO <br />•CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />BIIILOINC <br />PLUMBiNG <br />MECIUNICAL <br />ADD1110NAL PUN CIIf:CK <br />OIHER <br />STA7E 9111101H6 SIIRLIIafiOE <br />f'IIBI lf. WORNS <br />TOTAL <br />SUB TOTAL ; � <br />PEflMIT S � <br />1 OTAL �cE S � <br />J i7,�. /,� <br />FEE y3 pECEIPTND. <br />J <br />VALUATION FEE <br />/Z 37 77� �� <br />� ' �0 <br />_ G �� i o c> <br />