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�-. <br />APPLICATIQ�^� FOR COIdSTRUCTI.�N PERHAIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•BB10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �% J� (Q ,('j���,_y 13 �V.� . <br />E�rE Sy�r� .P.J.f��x 3rou E,.en�rr 982cL3 3ss- ���8' <br />ONTlER � MML�OD11E55 CIIY 7i� PIIONE <br />s.�� <br />TENANI MAIt�DIX1F.55 CIIY IIV <br />•i1GHIiECT W1 UESIGNEiI M�II I�DOOE55 LIIY <br />GENE1UtCONip�CfOR M�II�ODRE55 GIY 7�P PnONE SfAIEIICENSE� <br />�ece�.oa-ri�e �-Ir��cr�� c/u�aE,krcc.n�vWn-d#7 �.Eaec�- 9��zt3 �a9�4�e �r�v��}t�aodo/ <br />MECHN/IC�LCONTR�C70R M�II�DDRE55 f.11Y �!iP B�NE ST�TEIICENSE� <br />%UMBINCqklTRA�TOR M�ILADDRE55 GItY !IP P110NE STAIEUCENSE� <br />DESCRIBE VNi1N �NO SW�RE FOO7�GE INVOIVED <br />NE �n1 <br />C�r <br />wr __._ e�ocK <br />PNiLEIT�IIID.NUMBER <br />CONSI/tUCT10N l0lW LENDER, �00{IE55. TElEV110NE NUMBER <br />TYPE UF flI(TURE OA ITEM <br />LAVATORY <br />SHOWER <br />C:OTHES WASHER <br />URINAL <br />BACKFLOW PREVENTEHS <br />SINK ISERVICE — BAR. ET <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FR011TSETBACK HfM SFTB�C1f SIDE SET9�CIt <br />USE IONE <br />NEIGNT IIMITAfION <br />0110UP�NCY NO ( <br />FIflE SPRINKLEq REI <br />FIRE AIARM REO'D <br />ior •nee <br />NO O[ UWELLM(i <br />UA115 <br />OGCUP�NT <br />V�CANI SIIE <br />❑YES <br />512E Of BLOORI <br />FEE <br />❑ NO <br />❑YES ❑ NO <br />HEATING SYSTEM: ,PJ GAS ❑ ELECTRIC ❑ <br />CONT�CI FEi150NANDPHONE NO <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE 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 GRANTINO OF A PFRMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OFi CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LQCAI LAW REGULATINO CONSTRUCTION OH THE <br />PFRFORMANCE OF CONSTRUCTION. THAT I AM AUTHOAIZED BV THE <br />OWNER OF THiS PROPERTY TO PERFORM THE WORK F09 WHICH <br />lPPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x � r�.�..P �---- � ���(� � <br />51 �7 RE �IE <br />CITY BUSINESS IICENSE NO <br />MECHAKAAL <br />NO. T'PE OF EOUIPMENT FEE <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />MZAL FIREPUICE <br />GAS PIPING <br />EXIIAUST FAN <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />1`UH CII[CK NIIMOfl1 � � fEF � �ECEIPT NO <br />01➢lGNti <br />1`111M01NG <br />MFp1n11iC�1 <br />RIXHIIONM PI�NCII(GN <br />on�En <br />SiRiF. OUIIDING SIIfIC11ApOE <br />CITY OF EVERETT rvipnr, wonns <br />LOCAL SALES <br />TAX CODE IS 3705 TGTAL <br />