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APPLIC�1TIOr1 FOR CONSTI3UCT, jN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />rl DEMOLITI�DN ❑ COMBINATION �� ❑ BUILDING ❑ MECHANICAL ❑ PLUMABING ❑ SIGN <br />GENEf1ALCONTMLTIXi MAILApORE55 C�IV 71P PI10NE SIATHIICFNSE� <br />MECHANICALCONiR�CTOR M�ILAUD(1E55 Cltt � ZIP PIIONE STATELILENSE� <br />_ �� � SUTE ILENSE <br />CONTflACT PRICE Of wORK /' ^ <br />!� <br />1 <br />pE$G71�9�y1Qf1Jj{�N SOU/�REf9OT/�G�INVOIVED (� <br />K 1�;11L IM l� �(1 ;1 <br />or ,�a� 4 �� av� �, <br />�C I Al� � ��ic��2f1 <br />PROPOSED USE OF BUIl01N0 <br />LEG�LDESCRIPTIOfI OF PROPERiY (5110WN BELOW 0 <br />LOi �� 9lOCK � OF_ <br />pARCEI TAX I.D. NUMOER �� n/���C� �/� <br />CONSTflUC7IONLO�IENDER. 0 RESS.TELEPf10NENUA�OER <br />PLUM8ING <br />TYPE OF FIXTURE OR ITEM; <br />WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK d DISP <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BP.R, ET <br />FOfl OFFICE USE ONLY: <br />FRONT SETOALK REM SETBACN <br />NEIGIIT UMITATION <br />11� <br />FEE <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE S <br />SIDE SEiBACK <br />lOT APEA <br />NO OF DWELLING <br />UNITS <br />occurni+r �o <br />qEA50N <br />REASON <br />ninasanrn'oAvet <br />D�TE �"l/' <br />FiEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />^HONE NO <br />I HEREBY CERTIFY THAT 1 HAVE FEAD AND EXAMINtU �ni5 <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 HEFiEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CON. RACTORS LAW 102 FiC AND 2 200 WAC. <br />� � �o <br />SIGN�TURE D�TE <br />Cltt O1151NE55lICENSG NO <br />NO. <br />A/C—NHNDLG UNIIS <br />FORCED AIR SYSTEMS <br />NEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />MEfAL FIREPLAGE i <br />FIREPLACEINSERT <br />GAS FIFEPLACE <br />GASRANGE <br />GAS PIPING <br />IXHAUST FAN <br />P�AN CII[CK <br />V�C�Nt S�tE <br />❑YES ❑ NO pUILDINf. <br />SIZE OF BLOGRI <br />n , / PlUlA01NG <br />% <br />IMENf MECII�NIf,RI <br />❑vE5 �NO <br />P001710NR1. �l�N C��fCN <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />O1HEf1 <br />$tAIE �u110��+6 SIIRCII�nGE <br />ruoi ir, wonKs <br />TOTAL <br />rcc <br />0 <br />SUB TOTAL S ; <br />PERMIT S _! <br />TOTALFEE E ; <br />ncceirr Na <br />