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APPLICATIO � FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />O DEMOLITION ❑ COMBINATION p BUILDING ❑ MECHANICAL ❑ p�UMBING <br />PROJECT ADDRESS: L,�7r1 �=. in „� __ _ ,\ r� � I � _ 61�' SIGN <br />uui <br />- .,.�� <br />ANpNTECTORpE51GNEf1 MNt�D�RE55 <br />CIiY )�P PMONE — <br />CENENALCpNTIUCTOR MII1LADpqE55 — <br />7 GIY zlp <br />��pl�ylr� ���(�'t•'j`�IL'S PIIONE SUTEUCENSE� <br />�f.'r,3S� l�)l�(MAvc�._ G 1.�_ . nC:�n�� ..... ._._ . . <br />Z�� FIIONE SfATE LICENSE � <br />PWMORMaCONIRACICd Mal�ApppE55 ' <br />CIfY ZIP PIIONE <br />STAfE11GEN5E � <br />cornn�crnmc[orvronn ' - � <br />� 2 S00.V� HEATING SYSTEM• ❑ GAS ❑ ELECTRIC ❑ <br />OESGRIBE VR71iK �NO SpUARE FppTAGE INVOLVEO <br />C A1 �J' iA.l i .�n � 1.J R l�� C�J / C c. �.� _. . n_ . CONTAL� PENSON �AND PHpNE NO . � <br />W <br />------....m�,•..•...r .�zmx �arowri ee�ow <br />�oT o�ocK <br />OF_ <br />PS• I IIEREBL' CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICA710N AND KNOW THE SAME TO BE TRUE AND COHRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�n�Hnwcor�E WORK WILL DE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI lqW qEGULATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED BV THE <br />OWNER OF THIS P,qr��qTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIO IS Mk�E AND I COMPLY WITH THE STATE <br />�� CO�� CT�,�', LAW 1�,Y7�qCW AND 296200 WAC. <br />••�.m aa..w �[rvUtn. eppqE55. TEIEPfIQ1E NUMBER <br />x <br />SIGN UR <br />CITYBU NE551 <br />V� <br />MECHANICAL <br />TVPE OF FI%TURE OR ITEM FEE NO. <br />WAiER CLOSET�TOILET) � <br />BATHTUB aC - <br />LAVATORY(WASH BASIN) ' FOAC <br />� HEAT <br />SHOWER � UNITi <br />KITCHEN SINK 6 DISP ; CLOT�, <br />DISHWASHER � HANG <br />LAUNDRY TRAY ; WATEI <br />CIOTHES WASHER � W�� <br />URINAI . <br />SUB TOTAL S <br />— PERMIT s <br />I Tl1TAI Fc� e �� <br />FOR OFFICE USE ONLY; <br />iRONT5ET11�CN PEI1RSFiPACK SIDESETB4LN <br />USE ZON � f �OI �REA VACANI SIIE <br />Jv <br />❑YES ❑ NO <br />HEIGHILIMITATION NOOFUWELLING SBEOFBIOGRI <br />UNI IG <br />NO (% <br />unit <br />OvEs ❑ No <br />� `"" CITY OF EVERETT <br />LOCAL SALES <br />�)'� .� � TAX CODE IS 3105 <br />-9 <br />� <br />AIR <br />DRYERS <br />0 <br />FJ(HAU57 FAN <br />� <br />i <br />� <br />� <br />SUU TOTAL S � <br />PERMIT E � <br />TOTAL FEE S � <br />PIANCIIGCRNUA Ifp � � fEf _ /O qFf.FIP)NO <br />-� / ; , ��.� <br />��( `;L7 <br />FEES VALUATION FEE <br />UUIL�INf. '�� � � <br />PlIl1Al11NG j <br />A�EI:IIRNIC�I � { <br />�DDIIION/.LPIANGnfGN _--- '-- � <br />O1HGI1 <br />STAIE OUIl01NC SUIICI�MGE <br />rum ir. wnnKs <br />iOTAL <br />� <br />