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APPLICATI4_ � �OR COt�iSTRtDCT.�)i�! PERMIT <br />GTY OF EVERETT • BUILUING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTP.DDRESS:_�q�)�i ��C1G��' .C'F �`vere�_� Jn. <br />owr+eR Mnnnooness cirr z�r m�or+e <br />��p L�cE�-�1 �QU -�l l��avr. �.� � ,.er�l-IG.7a. 4��n3 �D(n 34 Y �9•7 � <br />TEN�NT �41LApORf.SS GIiV � I�P P110HE <br />iQ C�-I'�1 � <br />ARGNRECT OR OESIGNEn M�il ALO�iE55 Gltt ]IP P��ONE <br />GENERALCONiR�CiO(1 M�qq0��E5S CIIV IIP PiIONE 51AiEUCENSE� <br />CONTR�GT PRICE OF WORK /J <br />FD � <br />DESCRIBE M'ORK �ND SOUI.RE FOOT�GE INVOlVEO <br />,�Ue�O <br />LE W� OESCRIPTION OF PROPEPTY ISNOWN <br />�or e�ocK <br />PARCEL TAX I.D. NUMBER <br />'73I6 _ r�oo - n 14- - �v� <br />CONSTRUCTION IOAN LEN�E(1. �ODf1E5S. TELEPMONE <br />, NO. TYPE OF FI%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNORYTRAY <br />CLOTHcS WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, El <br />rv+o corie5l <br />FEE <br />0 <br />A <br />tl <br />SUB TOTAL S ' <br />PERMIT S <br />—I— TOTAL FEE 3 � ' <br />FOR OFFICE USE ONLY: <br />FRONTSETOFCN PEAfiSETORCR SIDESETBACN <br />USEZONE IOI�REA VAC�Ni5�1E <br />❑YES ❑ NO <br />HEIGHT LIMITATION NO OF D'NELLING SILE OF OLL :R.1 <br />UNI IS <br />Of S�OUIES <br />FEO'D <br />._ _ _._ _J unre <br />OASEMENf <br />❑YES ❑ NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />NEATING SYSTEM: (� GAS ❑ ELECTRIC ❑ <br />I HEREE3Y CERTIFY THAT I HAVE READ AND EXAMINEO TMIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF 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 REGULATIPIG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUl'HORIZED 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 10.27 RCW AND 296.200 WAC. <br />g , �,1��., �1. �0 - �'l - % lc� <br />SIGN flE ^ •� I [n � � OA7E <br />l%, <br />CITY OUSINESS IICENSL NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A/C — MiNDLG UNRS <br />FORCED AIR SYSTEAIS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WAT[R HEATER <br />WOOU STOVE <br />METAL FIREPLACE ( <br />FIREPLACEINSERT <br />GAS FIAEPLACE /� <br />SUB TOTAI 8 <br />PERMIT 5 /� � <br />TOTAL FEE S 7 , <br />rinNc�iecKr+uunrn Fep nEceirrNo <br />S'3as7 <br />OIIII�ING <br />PIUA�OWf. <br />bIEC11nNILAI <br />A�U�710N01. �UN �II(.CH <br />on�en <br />srnt[ ouunwc suncunnae <br />rum �C wonkS <br />TOTAL <br />