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APPLICATI� FOR CONSTRUC7�N PERMIT <br />CITY OF EVERE'T • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEk16LITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING �SIGN <br />PROJECTADDRESS: �� 3G EVER6RE�1 wa✓-. <br />pNMF.q MNLAOdiE55 Cltt iIP PMONE <br />�.6s sc.ra�.rAa -�r2K «ni Mana,4c �.�,,,�._/_�rlc�.��_o2-3a5i��T7 -�/�3� <br />lE1UN7 MNI/�WnE55 cAlr Im riwNc <br />L�G�/.t� ,�,� q7 36 ev •iF�,pt �✓ 9k71,i <br />ARCMTECT ql DES�CNER MNl ADORE55 GITY JII+ P110hF <br />GENEH�LCONTP�CTpi MNlI�00RE55 dTY llf P�IONE SUTEUCENSE• <br />CITV <br />PLUMBkNiCONTRACTOR MAILAOIX1E55 CI`V ZIP PHONE STATELICENSE� — <br />b <br />iot e�ocu <br />� r�i r�z i.o. rrn�aen <br />CpN$TRU0710N LOAN lENOEH.I�1D[N�ESS. TELEPNONE NIMBEH <br />TYiE OF FlIITURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />UVATORV (WASH BASIN) <br />SFh+WER <br />KRCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV � <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL <br />PERMiT <br />TOTAL FEE <br />FOR OFFICE USE ONLY: <br />i�q11T5ETBACK � PEMSETB�CN <br />�OId" Z�jIC,.�� /J1f <br />I �pT11RE11 <br />�I I <br />REO'D <br />BY <br />0 <br />FEE <br />� <br />S <br />S <br />SIOE SETB�C � <br />ra <br />V�G1NT SITE <br />❑YES <br />SIZE OF BlD6^I <br />❑YES ❑ Nq <br />HEATING SYSTEM: ❑ GAS O ELECTqIC ❑ <br />I F�EREBY CERTIFY THAT I f1AVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND nRDINANCES GOVERNING THIS TVPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 6RANT{NG OF A PERMIT OOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6ULATIN6 CONSTRUCTION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BV TME <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATIGN IS MADE AND I COMPLY WITH TME STATE <br />CONTRACTORS LAW 1827 RCW AN 298200 WAC. <br />��� � r-�-'T!�--- <br />D�IE <br />//C /'S <br />CITY BUS�NESS IICFNSE NO. <br />TYPE OF EOUIPMENT _ FEE <br />A/C — /VHNOIa UYITS <br />FORCED AIR SYSTEMS _ <br />CLOTHES ORYERS <br />STOVE <br />PIPING <br />1UST FAN <br />BURD�Nf. <br />pIUMBMG <br />MECn�Nlf.�l <br />�DDIIIONM. PUN CPF.CN <br />OillE� <br />ST�IE BUIIDINC SUI1GHAfifE <br />CRYOFEVERETT runiMwonKs <br />LOCAl3ALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL f <br />PERMIT f <br />TOTALFcE S <br />IEF /./�� IAECEIPTNO <br />L� � <br />