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, _ --. -- <br />APPLICATION FOR CONSTRUCTION PERIIi11T <br />Cli'Y OF E'JERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 982U1 • 259-8810 <br />il DEMOLITION COElBINATION f� BUILDING f1 MECHANICAL il PLUMBING fl SIGN <br />PROJECT 4DDRESS I�� O�� �-�- �V. \ t J��(� <br />�t' <br />Q�]ER MRILAODRE55 C�tt ZIP '9 PNONE <br />:l�l`i� �111��''��;J.i, I��E�J F-�Ill'IQII �N��ITY ZI�.66i�.��k /ClA'( E�I�Q�W� I <br />—�_ <br />ARCNItECTOR0E4WNEN MRILAODRE55 CITY ZIP PN�NE <br />0'iNERALCONTRACTOR M�ILAIXMiF'.5 CIiY IIP PIIONE SIATEIICENSE� <br />�,� �� mniinuuNess ��ry <br />;�iU.�� n_kll`�lJJ1P{ �►7l). >�( �7,12j tO..�� <br />PLI�ABINGCONiRACTOR MRILAODRESS QTY <br />�,Ja9� �l�'aw�a �aa N i �'�' S�t . �� � � � <br />CONTR�CT FRICE OF WpRK �— <br />DESCRIBE WORK ANO SOUARE FppT�GE INVOLVEO <br />� iY14�.., � � �Z� <br />�14s1 C. � I �O � <br />PROPOSER USE Q�g �UIL01 <br />1C 4 �t l�n �IA Q <br />LEQAL OESCPIPTION OF PROPEPtt �SHOWN BELOW ATfACH COPIES) <br />LOT'� BLOCK � OF <br />Q�-C� ��: 4Q � y QQ D� nc�.A.eS �. <br />S�1b.t��.Q �t�CQQ Q i �l � � <br />P�RCELTA1Cp.NUM� _ � ` C�S`O'� l.J\ C�l� <br />t.( l l <br />l ) -1 <br />CONSTRUC110N LOAN LENDER, AWpESS. TEIECHONE NUMBER <br />TYPE OF I <br />WATER CLOSET ( <br />BATHTUB <br />LAVATORY(WASH <br />SHOWER <br />KITCHEN SINK 6 [ <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTNES WASHE <br />UiiINAL <br />DRINKINO FOUNL <br />FLOOR DRAIN <br />BACKFLOiN PREVI <br />SINK ISERVICE — <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONT SETBRCN / REAR SET <br />USEZONE � IOTAREA <br />L ;� <br />HEI6HTUMIT�TIOtt NOOFOWELLING <br />UNI�S <br />OCCUPANCV IMO�S�ONFS OCCUPANIIOAD <br />HEO'C� <br />BY <br />STnTE LILF.NSE � <br />'_i�. �/TaO� � �J3`�H��E�S �1�AL�5i��E <br />HEATING SYSTEM: }�GAS 1 1 ELECTRIC fl <br />C�Af�T PFPSON AN� QIIpNc NQ p � <br />vl �U � l.� lPl !2 k't � r9 I I <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORqECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />i'ERrORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br />APPLICATION IS MADF ANJ I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 HCW AND 296200 WAC. <br />� Q Op�,� (a��9'� <br />SIG�� � DA <br />CITY BUSINESS LICENSE ND. <br />FEE NO. TYPE OF EOUIPMENT <br />' A/C—A/HNDLOUNITS—H.P. <br />� FORCED AIR SYSTEAIS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />i CLOTHES DRVERS <br />� VENTILATION FAN <br />i RANGE HO00 <br />� WATER HEATER <br />; WOOD STOVE <br />i METAL FIREPLACE (WOOD BURNING) <br />; FIREVLACE INSERT (WOO� BURNING) <br />; � GAS FIREPLACE <br />� GAS HANGE <br />' GAS PIPING <br />i EXHAUST FAN <br />SIDE SETBrI�p1C <br />O <br />V�CANT SITE <br />IIYES fi NO <br />PLN1 <br />ew�nwc: <br />SIZE OF Bl .1 <br />/�� 7� � / t'LIIMOING <br />r. <br />B EMENt � � MECNnNICAL <br />fIYES KNO — <br />ADDI110N�L PI.4N CHf.CH <br />O111ER <br />$TATE OIIIl01Nf. SIIRCIIMGE <br />CITYOFEVERETT runiir.wonKs <br />LOCfiL SALES <br />TAX CODE IS 3105 7oTAL <br />SUB TOTAL $ ; <br />PERMIT $ � <br />�— <br />TOTAIFEE $ ' <br />FEF. — RECEIPT NO. <br />VALUATION FEE <br />—T <br />S %�/� - <br />_"""'_f — <br />i <br />/n� _ <br />0 <br />