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APPLICATIOrr FOR CONSTRUCTItlN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •(425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL O PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 2 3.� � I b� -� � <br />L�,er..ld C,�-. '1-e.i�,-la� 32�z tb'=S�t l'� •IFf2u1 'Si-I�C' <br />OWNER j MAII,AppqE55 CITY 2iP P110NE <br />MRII r1DORE55 <br />GITY <br />P110NE <br />RRCHRF.CT OR OESIGNEP MRII �OORE55 C11Y IIP PNONf <br />GFNEII�LCONiRnCTOR MRILAOORESS G17Y 71P PIIpNE SfqfEUCCNSE� <br />G�er,•.er.. �-1�<�e Shvc-i Me'�-j P.^ /i•x �i �S Lrerrl� �1�2 6 2"'z 11�N LveRG� -�olkl <br />.............�.,.,.CONTqpCTOR MAI�AppqE55 CITV jIP PIIONE STATFLICENSE� <br />PLUMBING CON7Rnf,TOR <br />CONfR�Gi �qICE OF WOPK <br />��3(��) <br />DESCRIOE YKJRK ANO SOUARE FppTAGE INVOLVED <br />�1e.'�' "/tl/e�t�i.tS� <br />PROPOSE(D' cUSE OF BUII�ING � - <br />�'1'M �« Y �^�nrP �\ u ��SC. <br />LE W L OESCRIPTION OF PROPERTY (SHOWN BELOW OR ARACM TWO COPIES� <br />LOT DLOCK OP <br />CONSTFUGTIDNLOAN�EN�ER,AODRESS,TELEPHONE NUMBER <br />1 <br />. PLUMBING <br />� NO. TYPE O! <br />� WATER CLOSET <br />BATHTUB <br />LAVATORY(WAS <br />SHOWER <br />KIT�HEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />FIXTURE OR ITEM I FEE <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAF. ET <br />FOR OFFICE USE ONLY: <br />FRONTSFTFlACN REAR SETBACK <br />USE ZONF I l OI RPEA <br />ZIP <br />STATE LICFNSE � <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />CONTACTpFR50NANOPHONENO <br />"-�o.. Prrr�'r� �S, ,:iiz_3ii <br />I HEREBY CERTIFY TFIAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AN� CORRECT ALL <br />PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THF GRANTING OF A PERMIT OOES 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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOfiiZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296200 WAC. <br />x � ����,,,� 11-u-9'7 <br />$IGNAT DA1[ <br />CITv BlI51NE55 UCENSE NO <br />NO. TVPE OF EQUIPMENT <br />A/C—A/HNDLG UNI7S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />% UNIT HEATERS /n n n <br />WATER HEATER <br />� WOOD STOVE <br />� METAI FIREPLACE <br />; FIREPLACE INSERI <br />� GAS FIREPLACE <br />; GAS RANGE <br />:.) GAS PIPING <br />� EXHAUSTFAN <br />� <br />� <br />SUB TOTAL 5 ; <br />PERMIT 5 � <br />TOTALFEE S ' <br />SIOESEIBRCN PlANC11EGNNUMflfR . <br />HEIGHT IIMItqTION NO OF DWEILING <br />IIN11.`. <br />OCCIIPANCV NO 04 SL�niFS O(:CUPANi �ppD <br />GROUP <br />VPCANT Sli[ <br />❑YES ❑ NO <br />SIZE OF OLOGRI <br />❑YES ❑ NO <br />flW IDIN� <br />PI IIMAINO <br />MFCM�NICAI —_--- <br />�DDiiIONAI. Pl AN CMF.f,H <br />OIIIER <br />SiAIC f311ROWG SIInCI1nqGE <br />f,ONSi PL4NS APPPOVED OY GTY OF EVERETT runnr. waoKs <br />LOCAL SALES -- <br />,,,.� . TA% CODE IS 3105 TOTAL <br />SUB TOTAL S � (/ ; <br />PERMIT S '� <br />TOTAL FEE $ <br />FEF �FCFIf'TNO <br />i <br />