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� � <br />APPLICATiI.rd FOR C�ONSTRUCI.ON PERIIAIT <br />CITY OF EVERFTT • BUILDING DIVI510N <br />3200 CEDAR STREET • EVERETT, WA 9820 i• 259-8810 <br />fl DEMOLITION f-1 COMBINATION Gd BUILDING f� MECHANICAL f l PLUMBING fl SIGN <br />PROJECT ADDRESS <br />3i 21 s' D�iu�_ 5� Ev�r.�=rr wa. &zc�4 <br />OMMER MAILApDRE55 CIiY ZIP {+MONE <br />GiENE FR�anIc�S�v 2342Fc I�)T"a�t.S.E.dr� l3or�+[�c �,�,�.5�_z� (1�Hoz-y34G� <br />SEIMM MAILAODRESS f.ITY 21P � P110NE <br />< . <br />�IarY�GcL �QuL iH�mF_•5 ('C1: LIV',tiG ING.� Z�Si f11A1�J �1. �Ft.lYliD'J�F_�TCWN Ct.C(,y57 �203�343�5�7'7 <br />ARCHITECT OR DESIGNER MMl ADDRESS � CITY IIP PHONF. <br />�CVIFW �y: �ESi4u :-�N�S 19iS vn-AOISonI �. cvERErr�wn. i2ab) 3S3-OS� <br />GENERALGONTR�CTOR MnILA�UfiE55 CIIY ZIP PIIONE SIAiELICGNSE• <br />���=�roo-r' (3�.o2s. 57z4 ����cau�. �. rVr"�ErT u.�R.`i&ao� i��C,r2 :�iiot,�, <br />MECI."NICALCONTRACTOfl MAIIADORE55 CITY 7.IP r FIIONE STATELICENSEt <br />Uuk�,�o�.�,N- g,R ��,sa-33�7 �,�-9-9i, <br />PLUMBINGCONTRAf,TOR MAILA�DRESS CIN ZIP YHONE STAIELICENSE• <br />�INIWC4Ji;— DIV <br />CONTRACT PRICE OF WOAK <br />Alor KN�•c;;,� 73 �%7 <br />�ESC IBE 1VORK ANO SOl1�RE FOOT�GF INVOLVED <br />� ��.(i 2�51 D(�4+G. � J �� �JI <br />�u� <br />`( 7 % <br />PROPOSED USE OF BUILDING <br />P(�IMARV 2�s. <br />IEG�L DESCRIPTI OF PROPERTY (SHOWN BELOW OR ATfAL-� <br />LOT �` BIOCK _ _ OF <br />PANCELT�%I.D.NUMBER <br />CONST{7UCTION IORN LENDEH, �DDRESS, TELEPNONE NUMBEH <br />PLUMBING <br />NO. TYPE OF Fl%TURE OR ITEM <br />'L WATER CLOSET (TOILET) <br />Z BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, El <br />HEATING SYSTEM: L'3 GAS f-1 E�ECTRIC rl <br />CONTACT PERSON AND PMONF NO. <br />� HERE�Y CERTIFY THAT I HAVE READ AtvD E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BF TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIF.D HER[IN OR <br />NOT. THE GRPNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI'!Y TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAlJCE OF CONSTRUCTION. THAT I AM AUTHOAIZ:=D BY 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 A D 296200 WAC. <br />x 2a/ .� �G�� /;2 -aG �/"�S <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO. <br />FEE N0. <br />�- <br />SUB TOTAL $ _�/ ; <br />PERMIT $ ^i <br />TOTAL FEE S ! <br />FOR OFFICE USE ONLY: <br />FRONi SETPACK � REAq SFTBALK � <br />2-0 2 0 <br />1I5E20E1� LOTRRER <br />SI�E SETBACK <br />S <br />vncnNrsirF <br />�� I � 1 J� <br />HEIGHTLIMITATION � NO.OFOWFLLING SIZEOF <br />�7 � llNlt$ �Zi_� <br />FIRE AIARM REO'D <br />FIRF <br />OCCUPANTLO/•0 BASEAIENi <br />�/ /A IIYES <br />TYPE ?F E�UIPMENT <br />j FORCED AIR SYSTEMS — B.T.U. M <br />HEAT PUMP <br />— UNIT HEATERS — B.T.U. M <br />1 CLOTHES DRYEHS <br />� RANGEHOOD <br />� WATER HEATER <br />WOODSTOVE <br />� METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />— GAS RANGE <br />EXHAUSTFAN <br />PLAN CIIECK NUM[IFR <br />� <br />FEE! <br />f 1 NO OIIILDING <br />ONG_'f' PLUMOING <br />i�0 <br />MGCIIINICAI <br />Pfl�1710N4L PI�N G��CCd <br />OiHER <br />srmE DURo�`+C, suRCHnncE <br />CITY OF EVERETT ruFli ir, wones <br />LOCALSALES <br />TAX CODE IS 3105 TO7A� <br />SU8 TOTAL $ <br />PERMIT 5 <br />TOTALFEE $ <br />FEF. �j / RF.CEIPTNO. <br />7 ` <br />VAIUATION i <br />'7% V IQ � <br />FEE <br />- ., a'.;1..`i,:,,x:,, <br />�� <br />' �+� <br />� r i�i' ' <br />'7 <br />i ' <br />. `,�:y��::�i��� <br />'' t '� <br />_ �-�:�, �,t � <br />if <br />:� <br />- � �- � ��:Z... <br />