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APPLICATIL N FOR CONSTRIJCi .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />PFiOJECTAODRESS: S��/% Q�"✓�`�'�y L���✓� f✓i yRZo:I <br />_ /'L/-'i✓ �/-'�;Fr��'.2 S6/9 /�fvi�'cY �-d, 98�0.? Z�?O-/o2�i9 <br />Dr <br />TENNIT M�It �ODRE55 CI1V 7i� PI�ONE <br />�RLNRELTOf1pE51GNEP M�II�DORE55 �iry �ip <br />GENEM_ CONIPI.LIOR MAIL �OORE55 CrtY 7iP PnON[ SI�TE IILENSE � <br />Cl>-2 <br />��n' IIP PnON( ST�IE tILENSE � <br />PWMBINGCONIR�CTO{I MqLADDPE55 CItY Z�P P110NE ST�IEL�CENSE� <br />� — //GD <br />DESCRIBE WORN ANO SOl1�RE FOOTAGE INVOlVEO <br />/�c�i✓v£?T h�E.�: �t /,/o� J,a; � i <br />To it/.o r!/. !'.aC_ �,aS .�.vc�zv �C <' c i- <br />�fS, <br />vrroroseo use ov eunar+n <br />LEG�L DFSCRIPTION OG %IOPERTY I�aMM BEIOW OR �T1ACM TNq C01ME5� <br />lOi __ BLOCN OF <br />PARLELTNfI.D.NUMBEiI <br />CONSTRUCTION LONI LEN�ER. �OWiE55, TElEP110NE NUMBER <br />TYPE OF flXTURE OR <br />WATER CLOSET (T�ILET) <br />bATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNORYTHAY <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. E7 <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />iRON75ETpAC1t RE�RSFiMLIt <br />JSEIONE im�nen <br />NEIGHI LIMIiAT10N NO OF DWELLING <br />UNIIS <br />FIflE <br />NO M 5�(Mi;S � OCCUPANI IO�D <br />u�iE <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />CONI.1Gi VERSON �NO P/IONF. NO <br />I HEREBY CEATIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT 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 DOEG 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 />PEHFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEF OF TNIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE S7ATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x i�_=��ki��ir2-- �/-8- %,6 <br />SIGNiRUPE � - ORE <br />CITY OUSIHESS LICENSC NO <br />MECFiANICAL <br />FEE N0. T'PE OF EOUIVI <br />T <br />A/C — AMNDLG UNRS <br />; FORCEDAIRSYSTEMS <br />� HEAT PUMP <br />' UNIT NEATERS <br />i CLOTHES ORYERS <br />� RANGE HOOD <br />� WATER HEATER <br />�— WOOD STOVE <br />; MEfAL FIREPIACE �'JOOD I <br />� FIREPIACEINSERT�WOOD <br />� GAS FIREPLACE <br />; GASRANGE <br />� � GAS PIPING <br />SIOE SETB�Ck <br />V�C�NI SILE <br />❑YES ❑ NO <br />SIZE Of BLDGR I <br />B�SEMENI <br />❑rE5 ❑ NO <br />f'l �H CII[CR NlIMllffi <br />GUII OINf. <br />1'IUTAlIING <br />A�FCII�NIC�I <br />♦DDIIION�I PI�NC��lCk <br />on�en <br />suie nuuoiNc sunounr,e <br />CITY OF EVERETT runi ir, wonrs <br />LOCAL SALES -- <br />TAX CODE IS 3105 ioial <br />rrr <br />SUBiOTAL S <br />PERMIT S <br />11ff.FIPi NO <br />FEE <br />