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APPLICATIf�I FOR CONS"tC�I�CTI�DN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />p DEMOLI710N ❑ COMBINATION ❑ BUILDING U MECHANICAL � PLUMBING ❑ SIGN <br />PROJECTADDRESS: ej9�(� L'_VL�ITIK���� ��y <br />ONRIER MAILADORE55 CITY ZIP PIIONE <br />TENANT 4AILAUDRESE CITY 71P P110NE <br />AR(C�IIITCCT OR D('E�S�IGNER MNl AOORESS CIfY IIP p PIION�F. j <br />1 U I VLf�� �nN CL � ^— p���qE $fA7GUCENSE � <br />GENEf1ALGONiRACTOR MAIIAUDRE55 CIIV IIP <br />t�11fAlCONTRACTOR MIJLADDRE55 ^ PIIONE $TATELiCENSE� <br />c.nv zmn.. _. .„c ��.._ i �n.�c idiC <br />LOT <br />' PRIGE Of WORK <br />� <br />WbfiNAND SOUARE FOI <br />BUILDINb <br />BLOCN <br />� ��� <br />INVOWED <br />CONSTRlIC710N LOAN LENDER. �DUi1E55. TELEP110ME NUMBEfl <br />TYPE OF FlXTURE <br />WATER CLOSET (TOILEn <br />LAVATORY <br />KITCHEN SINK <br />CLOTHES WASHER <br />URINAL <br />DPINKING FOUNTAIN <br />BACKFLOW <br />FOR OFFICE USE ONLY: <br />LRONTSETBALN REARSETBACN <br />USE 20NE <br />IIEIGIif LIMIUTION <br />�: <br />21P <br />�- <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />CONIAG� PERSON ANu PMOHG NO <br />1 N� L ����P-%�1 i-6`�+S <br />I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PENMIT 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 PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLiCATION ISI MADE AND I�OMPLY WITH THE STATE <br />r.nNTRACTORS LdW 18.27 RCW AND 9.200 WAC. <br />J1'1 <br />x <br />SIG • <br />CITV BUSINESS UCENSE NO <br />MECHANICAL <br />FEE NO. TYPE OP EOII <br />� q/C—M+NDLGUNRS <br />� FORCEDAIRSYSTEMS <br />_� <br />� HEAT PUMP <br />� UNIT HEATEPS <br />' CLOTHES DRYEfiS <br />� RANGEHOOD <br />SUB TOTAL 5 i <br />PERMIT S � <br />TOTALFEE 5 ' <br />SIDE SET9ACN <br />IOTAREA <br />NO OFDWELUNG <br />UNI1S <br />OGCUPANiL0�0 <br />� <br />WCANI SIIf. <br />❑YES ❑ NO <br />5�2E OF OU%]rtI <br />BASEMENT <br />❑YES ❑ NO <br />CITY OF EVERETT <br />IOCAI SALES <br />TAX CODE IS 3105 <br />GAS RANGE ____� <br />GAS PIPIIJG <br />EXHAUSTFAN _,_ <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />riuic�iccK unrn reE nEr.EirrNo <br />�3 i �/� <br />FEES VALUATION <br />nminwa _ , <br />PlI1MI1M6 <br />NFCIIANICAL _ __ <br />ADOIIIONAI. PI AN C�RCN <br />OIIIFR <br />���_ <br />STRTE �UIID���6 SURCIInt1GE <br />����_ <br />PIIIII �C WOONS <br />TOTAL <br />FEE <br />