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APPLICATICJ FOR CONSTRUC7 JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />RICItlTCLTp10E51GNER <br />4ECNANICAL CONTMCTO{I <br />car/rrucr v�nce or won <br />% Z� <br />DESLRIBE VIORK �ND SdURE FOpTM.E li <br />� <br />citv <br />Clfv <br />�GIiY <br />���'_" <br />cirv <br />LEGAL OESCRIPTIpJ OF PROPER7Y �S/IOWII BEIOW ON AT7/iCN 1Nq COFIES� <br />�oi e�oac oF <br />�Wf1ESS. <br />NO. � TYFE OF FlXTUHE OR ITEM <br />WA7ER CLOSET (TOILETI <br />KITCHEN SINK 8 OISP <br />DISHWASHER <br />LAUNDRYTRAV <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. E7 <br />SUB TOTAL S <br />PERMIT f <br />FOR OFFICE USE ONLY: <br />vaa�rs�m�cK r+e�nseta,�cK <br />USEZONE liorene� <br />NEIGIIT lIM1iATI0N NO OF DWEWNG <br />UNIIG <br />OCCUPANCY 110 (%51(MLFS (xWP�M IO�U <br />FlRE SPNINNIER REO'0 <br />1'11VNG <br />GGIE IICFNSE � <br />PIIONE - SiAfE LILENSE � <br />-��3a- �l �oo <br />r�roNe sureueense. <br />HEATING SYSTEM: �HGAS ❑ ELECTRIC ❑ <br />CONGCT P[RSONAND PH(N1E HO . . . <br />]1_U' `-[�U C � <br />I HEREBY CEiiTIFY TNA; I HAVE READ AND EXAMINED THIS <br />APPL�CATION AND KNOW THE SAME TO OE TRUE AND CORREGT ALL <br />PROVISIONS OF IAWS AND ORD�NANCES GOVEflNINC THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TIIE 6RANTINO OF A PERMIT DOES NOT P�ESUME 70 61VE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OH THE <br />PERF�ORMANC'c UF CONSTRUCTIO�i. THAT I AM AUTHORRED BV THE <br />OWNER OF THIS PqOP TO PE RM THE WORK FOR WHICH <br />APPLICATION IS AD PLV WITH THE STATE <br />CONTRACTORS W 1 R 96. WAC. <br />x - <br />SIGN�NPE DA E <br />CITY BUSINESS IICENSE NO <br />EQUIPMENT I FEE <br />A/C—AMNDL6 UNffS <br />FORCED AIR SYSTEMS <br />METAL FIREPLACE <br />FIREPLACE INSEfiT <br />GAS FIREPLACF <br />5ioE5FTB�cK I�L�NCII[CN <br />WC�Ni SIfE FEES <br />❑YES ❑ NO p���L�INC <br />SIIE Of BIOGRI <br />1'1i14f11NG <br />B�SEMENi MfCN�NICAI <br />❑YFS ❑ NO <br />�DO�IION�L PI �N L��CCN <br />O111E11 <br />SI�IE Ol11lNNG Si1RCR�Rf.E <br />CITY OF EVEREI�i ruei �r. vronKs <br />LOCALSALES <br />TAR CODE IS 3105 TOTAI <br />SUBTOTAL f <br />PERMIT f <br />TOTAL FEE S <br />!Ef I �Ef.FIPf NO <br />