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9�! D APPLICATIl..�1 FOR CONSTRUC7 .ON PERMIT <br />CITY OF EVEkETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 982U1 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING 7 MECHANICAL f7 PLUMBING fl SIGN <br />PROJECT ADDRESS �� � 4 5G j,� 5� S W <br />p�y p MAILAD RESS CIN 21P PHONE ��333 <br />��'rvwood �r�� �r►G 14�10 b,/2rd 2d#�o �,�,1/.�uu.� 98ov7 <br />TENAN� MAILR]DRE55 Cltt ZIP PNONE <br />arv ziv r�unr <br />��Ty Z�p PHONE STATE LICENSE a <br />COLdNT.= �F31 C <br />MECHANICALCONTRACTOR MAILADDRE55 ���T �" "'-"- - �--- <br />PLUMBING CONTRACTOR MAILAODNESS CITV ZIP PHONE STATE LICENSE t <br />3y/z �j /Ytati <br />Rsic � �30 <br />SED USE OF BUILDING <br />LOT _S L_ BLOCK <br />S, 331r, o� <br />o�veo , <br />u c�! o�- <br />G7o � l,a <br />G. K • <br />9ELOW OF ATfACH TWO COPIE51 <br />_ OF <br />�al.-r- /an�l3 OJ� <br />PARCELTAXI.�.NUMBER � <br />SI ��.. pOd- .$ _ <br />COY.STi7UG7ION LOAN LENDER. ADDRE55, TELEPHONE NIIMBER <br />FLUMBING <br />NO. TYPE OF FlXTI <br />,3 WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK ISERVICE — <br />HEATING SYSTEM: �GAS ❑ ELECTRIC 1.7 <br />'ra� �►'u�roic � y 9- 8/78 <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 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 REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />�-!� 3�19s <br />X'�—� � DATE <br />SIGNA I1RE oa y �uy <br />CITV 9USINESS UCENSE NO. <br />OR ITEM FEE NO. TYPE OF FIXTURE OR ITEM <br />� A/C—A/HNDLGUNITS—H.P. <br />� FORCED AIR SYSTEMS — B.T.U. M E.A. <br />, HEAT PUMP <br />� UNIT HEATERS — B.T.U. M <br />— � CLOTHES �RYERS <br />- � VENTILATION FAN <br />� FANGEHOOD <br />� WATER HEATER <br />� _ WOOD STOVE <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK � REAR SETBA�N <br />2$ 2S <br />USEZON�j' LOTAREA / <br />/l� S � .���( <br />HEIGHT LIMITAT`ON / U�NITSF D%ELLING <br />�8 <br />A <br />REO'D <br />TVPEOFCONST. PLANSAPPR VED Y <br />-�/ �v <br />.J� — � na1F 2 /10 �' <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />SUD TOTAL $ i i ' <br />PcRM1T $ � <br />TOTAL FEE $ ;_ <br />SIDE SETBACI� PLAN CNECK NUMB FEE REC9PT N0. <br />�. s 7[� �a- <br />VACANT SITE FEES VALUATION <br />�YES ❑ NO BIIILDING Z3� Q[�`� <br />7FBI.DG ��V/N4 <br />6y S f G.�RA� P�UMBING <br />BASEMENT � � MECHANICAL <br />❑YES fYNO <br />AODITIONAL PLAN CHECN <br />OTHER � � � <br />S.ATE BUIL�ING SURCN�RGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />, TAX CODE IS 3105 TOTAL <br />r <br />