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APPLICATIQ�' FOR CONSTRUCT� �N PERMIT � <br />TO BE COMPLETEO IN BLACK INK—PLEASE PRINT <br />HEATN�G SYSTEM: ' GAS ❑ ELECTRIC `:.1 <br />BUILDING DEPARTMENT <br />259-8810 <br />I I DEMOLITION I I COMBINATION ! I BUILDING ✓�YIECHANICAL I' PLUMBING ; SIGN <br />OWNER M�IIADDRE55 CITV IIP PHONE <br />/�NyLL/S Tqexso.J 3ia S C�-.qBor �o. 99�o a �S3 -�353 <br />TEN�NT MMl ADORESS CITY 21P PNONE <br />�RCHITECT OR OESIGNER MAIL �DDRESS UTv ZIP PHONE <br />OENER�L CONTR�CTUR M�IL �OOHE55 QTY IIP PMONE SiRE LICENSE � <br />MELH�NIL�I CONTPI1C10P M�IL AOORESS CITY 21P'74(_�j �S PNONE STRE LICENSE � <br />rbs79t i,E147�/��s /97A/ G�/rs.i9�� �J �rNNwoen 9PC��L .r�677L+vA07'l f,i <br />VIUMBIN� CONTRICTOR M�IL �ODRE55 CITY 71P PHONE ST�TE LICENSE I <br />CONTR�C7 PRICE OF WO]RK <br />/ �l <br />DESCRIBE YIORK AND SOU�RE FOOTAGE INVOLVED <br />OF PROPEHTY ISNOVM BELOW OH AT7ACN TWO GOPIE51 <br />LOT BLOCN <br />P�RCEIT�%ID.NU4BER <br />!O!!� <br />LONSTRULTION lWN LE! <br />0 <br />�D — O SS — 1 <br />1100RESS, TELEPNONE NIIMBER <br />� <br />KITCHEN SINK 6 DI: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />FOUNTAtN <br />ROOF <br />SINK ( <br />FOR OFFICE USE ONLY: <br />FRONTSEiB�CN RE�R: <br />rrrc a coHsi <br />S1IE OF BIDb <br />OCCUP�NGVLO�� <br />REA9uH <br />INT�NE BY <br />SU8T0 <br />PERMIT <br />LOT ARE� <br />NO OF STORIE6 <br />FIPE 5PPINNlERS REO'U <br />FIRF. �UNM REO'D <br />PUNS �PPPOVED BY <br />D�TE <br />SIOE SETBIICR <br />VAC�NT SITE <br />r � ves n No <br />occunr�r xoduwt�inroux�rs <br />enwv <br />B�SEMENT <br />n ves r,: No <br />HEIONT LIMIT�TION <br />CITY OF EVERETT <br />LOCALBALES <br />TAX CODE IS 3105 <br />LONT�CTVERSd1�ND <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNINp THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE �FiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PflOVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIIED BV THE <br />OWNEH OF THIS PROPERTV TO PERFOHM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 29620D WAC. <br />Y /l'(..�..t.�+,e..(� //�G�l� <br />s'°""''�` Oa?7/S/ °"„ <br />CI1Y pU9M1[591Kf NSt M _ <br />PE OF EOUIPMENT <br />G UNITS—H.P. <br />SVSTEMS—B.T.U. M <br />IS—B.T.U. M <br />RANOE HOOD <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN <br />HEAT PUMP <br />GAS PIPINQ <br />E%HAUSTFAN <br />BUILDINO <br />PLUMBING <br />MECHRNICAL <br />�ODITIONAL PUN CHECK <br />OTMER <br />STRTE 9UILDING SUHCHARGE <br />PUBLI(� WOFrS <br />TOTAL <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />PECEIPI <br />i <br />T <br />