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APPLICATIOh FOR COI�OSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING OIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEhAOUTION ❑ COMBINATION LK' �UILDING ❑ MECHANICAL ❑ PLUMBING p SIGN <br />PROJECT AODRESS: � RA�N PqL,�E �Pc.SY�iYikAN � <br />�Nnl✓ NA/1.G �/3�S �P�K�,Q �4✓c �v�Pr�/- 95.203 2�2 GL',1p' <br />OWHER MULA0ORE55 CrtY piP PHONE <br />Ne /-lAU �13os' 7J a-�i 7 c' �t <br />TENAM MMLMORE55 CIIY )IF P��ONE <br />�RCMTECTqi0E5iGNER M�Il�00RE55 Cltt ]m PNONE <br />[{IPil16EGlA4' 38e't�t,,nnnt��nra n,o,ekAvF�/ su �i9log 6ado400 �a�,�d�-�s�e-�n 4c����k3 <br />E�i NER�IGONTqA�Tpi MAILADORE55 � )If` PIION[ SfREUCENSE• <br />MECHhNIU�ICONTRA�TOR M�ILADpRE55 Gtt T�P F110NE STREUCENSE� <br />%UMEMGCONTR�CTOR M�II�WRE55 Cltt 21P PNONE SiA1EUCENSE� <br />CONTMCT PRICE OF VARK <br />mvaveo <br />�oT e�aK <br />. ---- �aa � ��a5 c� i D�ov <br />CONSiRVLTION LOMI IENDER. AODilESS. IELEP110HE NUMlER <br />� <br />FlXTURE OR <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TRAY <br />CIOTHES WASHEH <br />SINK (SERVICE — <br />SUB <br />FOR OFFICE USE ONLY: <br />SIDE SETB�CIt <br />USEZONE IIOT�REA IV�C�NLSIfE <br />❑YE$ ❑ NO <br />HEIGMT LIMITATION NO OF DwELIING <br />UNIfG <br />OCLVV�HLT M p StMtlFS OCCU��NTLO�D <br />OROIIP <br />FlRE SPRINNIEN REO'D <br />S12E OF BIDGRI <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I1ND 1`MONE NO <br />I HEREBV CERTIFY THAT I HAVE HEAD AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TNUE 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 />AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINCa CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEfi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br />CONTFACTORS lAW iB27 RCW AND 296.200 WAC. <br />I N�TURE OAIE <br />CITY BUSME55 LICENSE N0. <br />rv�. — rvnrvuu <br />FORCED AIR 5' <br />HEAT PUMP <br />UNIT HEATERS <br />WOODSTOVE <br />MEfAL FIREPLACE � <br />FIREPLACEINSERT <br />GAS FIREPIACE <br />GAS RANGE <br />PI�N CIIECN NUMPEf1 <br />��a 7 <br />OUI�DINC. <br />P111401NG <br />MECNANICAI <br />�DDtIipNM. f'I AN �9(CN <br />OiuEO <br />51�1[ OUIIDMG SIIRCIIAOGE <br />SUBTOTAI S <br />PERMIT 5 <br />TOTALFEE 5 � <br />REf.EIPT NO <br />LUIITION FEE <br />/ / / <br />)/Y.) � � �i i �(? <br />7 l <br />CITY OF EVERETT rimiicwonHs � <br />LOCALSAIES <br />TAX CODE IS 9105 ioin� .; /j �! , j <br />