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i <br />APPLICATI4.J FOR CONS'�RUCT►JN PERMIT <br />CITV OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />�DEMOLITION ❑ COMBINATION p BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ' � <br />Cf'�I � r� t 1( l;.C� { G_ t�- C,l �t�, <br />l' l C(� '�-, c l-�"�� � <br />TENANT uNl <br />�RCMITCCTORDESIGNER M�II <br />I?(; ����c�x <br />CITY <br />CIiY <br />�,_��.�,��t�°�� t <br />TIV PI�ONE <br />7�r <br />GENEf1ALCONiMGTOR MMIADDRE55 LItV 7�� PIION[ FUTEIICFNSE� <br />�i�I �il.�_ <br />MfCHI�NICAI CONTRIICTOR MAIIADDf1E55 CI7Y T6` ���Or1E SiQE LICENSE � <br />PWMBINGCOHIH�CTOR MAII AOORESS CItY 21P P110NE S1AIE IICENSE � <br />GONTMGT PPoCE OF Y/Of1K <br />NqRN ANO SOUARE fOOT�GE INVOLVEO <br />P(qPoSED USE OF <br />LEGAL DESCRIPTION OF PROPERtt (`+�w� BI <br />OIOCN <br />�c,L.�_�:� <br />�,��o-o��,-co�- aac,�,. <br />CONSTIIUCTION IONI IENUER. AWPE55. TELEPHONE HUMBER <br />PLUMBING <br />NO. TYPE OF <br />WATER CLOSE'f <br />BATHTUB <br />LAVATORYIWASI <br />8 DISP <br />LAUNORYTPAY <br />CLGTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BA'�KFLOW PREVENTERS <br />SIIJK ISERVICE — BAR, ET <br />FOR dFFICE USE ONLY: <br />iRONTSETP�CK AE�R SFTBACN <br />USElONE <br />HEIIiNT UMIT�TION <br />IX:GUPANCY Iq C <br />GNWP <br />IOf�REA <br />� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE f <br />SIDE SFTB�Ck <br />NO OF DWEIIING <br />UNIIS <br />FEE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT VCRSON ANO PMONE NO <br />I HEREBY 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 SPECIFIEO NEREIN OR <br />NOT. THE 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 REGULAI •NO CONSTHUCTION OR THE <br />PERFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPI Y 1V!TH TFIE STATE <br />CONTRACTORS LAW 1027 RCW AND?96.200 WAC. <br />"��'� � ���;,�>'1 ,-9 �-��--��r <br />SIGNRi U�TE <br />CITY BVSINE55 LICENSC NO <br />MECHANICAL <br />NO. TYPE <br />FORCED AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CLO7HES DRVERS <br />WOOD STOVE <br />METAL FIREPII�CE i <br />FIREPLACE INSEHT <br />GAS PIPING <br />EXHAUSTFAN <br />PUN CIIEfN <br />V�L11H� VfE �c�� <br />❑YES ❑ NO BUILNNG <br />SIIE OF BLDGrtI <br />PIUMpMG <br />B�SEMENi MEf,N�NILM <br />❑VES ❑ NO <br />•DOtl10NAL PI AN C��f LN <br />o��En <br />sr.ie ounoiNc sunc�unae <br />CITY OF EVERETT rviniv.won�s <br />LOCALSALES <br />TAX COUE IS 3f05 TOTAL <br />ffF <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE f <br />BFf.F�PI NO <br />FEE <br />