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APPLICATII...�1 FOR CONSTRUCti .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 88201 • 259-8810 <br />O DEMOLITION ❑ COMBINATION �`]i BUILDING� ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: lj�-/Z �r'.r�5� � r -1 ,!� • <br />1� SS� - <br />w�oNc <br />�11LMTCCTOPiDE51GNEN YiUI�WqE55 CItY )m p�pr,E <br />,Le.tisA�' DC"p <br />MECNNAL/iL CONTR�GTOR <br />MIJI �OORE55 <br />�WnE55 <br />�� <br />� aa <br />Pi WNF <br />PIVMBMKsCONfRAGTOR 4MlADDi1E55 CIfY IIP P110NE S1AfElIGENSE� <br />corirrucr vnice ov wrnK �3y��1� Bd <br />oescne¢ wonK u+o souu� roouae wvaveo <br />LOT BIOCIf <br />r�olo Occo ccx�3 <br />�D011E55. TELEP110NE NUMBEN <br />TYPE OF FlI(TURE OR ITEM <br />WATER CLOSET (TOILE� <br />BATHTUB <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />UUNDqV TRAY <br />CLOTHES WASHER <br />— BAR, <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />iRONT SETBACIf NE�R SFTBACI( SIOE SETBhCk <br />USEIONE IIOI�REA <br />NEIONTUMItATION NO Oi OWEllIN6 <br />UNIfS <br />OCCUP�NLY x0 p SIMES OCCUPIINI IO�D <br />6ROUP <br />oArE <br />FEE <br />HEATING SYSTEhi: ❑ GAS ❑ ELECTRIC ❑ <br />cowucr rrnsor� �Ho rHor+e r�o <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPIICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PqOVI510NS OF UWS ANO OROINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN ON <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR TH[ <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNOHI2ED BV THE <br />OWNER OF THIS PROPEF7Y TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I QMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 W A7D d.zoo wnc. <br />x �I �'/i ' / <br />�!L �i' .c,�r`l /n� _ <br />516N�fURE �� U�TE <br />CIIY BUgNE55lICENSC NO <br />MECMANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DHYEHS <br />RANCEHOOD <br />WATER HEATER <br />WOOD STOVE <br />PERMIT f <br />TOTAL FEE S <br />ri�NartcKr+uunrn I�FF I�fr.FmrNo <br />VIC�NI SIfE Ytt3 <br />❑YES O NO nlnlDiN(i <br />SIIE O� B100R I <br />PlUM01NU <br />B�SEMEN� MECIUNIf.�I <br />❑YES ❑ MO <br />�Dp IION�I Pl �N Luf L1t <br />nn�Fn <br />Sl�1E Bl11lDIN(1 SIIi1CNN1(iF <br />CRY OF EVERETT runnr, wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />