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APPLICATIGA FOR CONSTRUC?.ON PERMIi' <br />CITY OF E4ERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />f I DEMOLITION f I COMBINATION rj�' BUILDING ' i MECHANICAL ' i p�UMBING I! SIGN <br />PROJECT ADDRESS <br />S Z 9 �! E Ec%/ s T. <br />owr+En M.n eooness arr r�r r�roae <br />�4�vn� %r4/L✓�`sL S29 dEEc.p �i/Eys�Tr i8ta3 355-754n <br />1ENIINT 1AMI MDRC55 Cltr Tln pr�ONF <br />�.M:MITfLiO(1�CSiGHlR MMI MID��hS1 <br />u.n ��nness <br />Cl/Y 71P <br />rnr rm <br />suie i ir.rNse . <br />_,QY O w .v F� <br />MEJN� IUl CONIRRCTOP MAit RDPRF55 (:ITY 71P PIIONF SLQE UCFNSF • <br />PIUMBINGCONiMC1pR MMI 110bRE55 CItY ZIP I+I�ONE SIRIF UCFNSE � <br />CJNTR�CI PR�CE O! MIORN <br />2 Sm o.•� <br />� <br />CESCRIBF N�NOSpU�RFF00T�GFINVOtVED <br />ba! <br />lE[i�L OESGRIPTION Of PRpPER1Y �SHOWN BEIOW OR �T1ACH T WO COPIE 51 <br />ior 2'7 e� ; or BE�E�-c.�,L <br />n.... e. _ . , fx' I <br />CONSTRVCTION IO�N LENpER, �IXN1E55. TElEP110NE NUMAFN <br />OH ITEM <br />WATER CLOSEi <br />BATHTUB <br />LAVATORVIWAS <br />LAUNDRVTRAV <br />CLOTHES WASH�R <br />URINAL <br />DRINKING FOUNTAI <br />— �AR,ETC <br />SUB TOTAL E <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLV: <br />fIIONT SFTp4CN PF�fI GFip1f.N SID[ SEfP�f.N <br />USG 70NF IUI�RE� <br />IIEIGHT LIMIiAT10N NO (X IIWCIUNG <br />IINItS <br />OGGUP�NCV M� M Slnail5 IX:f.UPAM 10�U <br />r,noun I � <br />_—'L — <br />nqF�U114REOD n�ecON <br />fIRFSPpINIqFfiRfqp OfA<ON <br />IYPF O! cONGI PI �Nti nPPnnVf [� <br />� <br />�" l.j t�i <br />-- _ �,.,, _�� <br />HEATING SYSTEM: I i GAS � I ELECTRIC I <br />CONT�Ci PfP$ON RN� PIIONF NO <br />JA ( � � � ?�if i�r—.r1 1 G C � � <br />Ic�/V�•y �T/l/�/i�L��L/ /'CL � �}'j}' <br />1 <br />1 HEREBV CER7IFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE ANU CORRECT ALL <br />PROVISIONS OF LAWS AYD ORDINANCES GOVEFNING TNIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PqOPER?V TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LA'N 1827 RCW AND 296200 WAC. <br />x T.�,.._. � 8�25� 9s <br />SIfiN�TURE 0�1 <br />CI1Y BUSINF.SS lif,[NSC NO <br />FEE NO. TYPEOFEOU�PMENT FEE <br />� A/C—AMNDLGUNRS—H.P. <br />� FOFCED AIR SYSTEMS — B.T.�. M E.A. <br />� HEAT PUMP <br />! UNIT HEATERS — B.T.U. M <br />V�C�NISILF <br />liyE$ I"� NO <br />SRE Of qlIXi91 <br />,��fc, 'V"+'i <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 7105 <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />SUBTOTAL S <br />PERMIT 5 <br />TOTAL FEE E <br />PI�NCIIfCN�IM�f�// I�lf IAFf.FIPiNO <br />nunnivn � 3�`/O � /n'i< 100 <br />PIIIMPI4 � i <br />— ___._.__._ --___�—_. <br />I <br />MFf11nNIC�L i <br />__" —"_._—_ i -.._ . <br />�pU�IiON�I M�N(:�IfCN � <br />i <br />_ ___�". _ _ . _ <br />nn�Fn <br />SiME nUilOR1G SIInGUn(;C U/' rrJ <br />___ —__ __—_.—_.__ __—__�L--iJ_." <br />PIIpI If yW1PNt ' <br />---------------- - -----_ ___ ._.. <br />TOTAL <br />