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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-B810 <br />fl DEMOLITION fl COMBINATION t� BUILDINO � MECHANICAL rl PLUMBINQ I 1 SIGN <br />PROJECT ADDRESS _ � ,. <br />uu��oo�ss _ � _ cirv <br />— - v� �— v ._ r- � r <br />TEN�NT MNLAtlOqF.55 CIIY )�P FNONE <br />11RCMTECTOROESIGNER M1111.AODRE55 �ITY )IP �HONF. <br />GENEMLGONIRACTOfI M�IL�DIX1E55 GIIY IIP pNONE SU1iElICENSE� <br />�.�ECN�NICIILCONfP�CTOq M�ILADDRE55 CITY ZIP PI10NE STIITEULF.NSE� <br />1� ' `\ <br />NORKANO <br />iEw� oescmrna+ oc rHob <br />ior aiacu <br />FOOT�E <br />uir <br />�,GQ�A'��� <br />,,. <br />NO. TYPE OF <br />WATER CLOSET� <br />BATHTUB <br />LAVATORV(WASF <br />SHOWER <br />KITCHEN SINK 8 <br />� DISHWASHER <br />IAUNORYTRAY <br />CIOTNES WASHE <br />URINAL <br />DRINKIN6 FOUNI <br />FLOOR DRAIN <br />BACKFLOW PRE� <br />FOR OFFICE USE ONLY: <br />R10NT SF.Tpl1CN RF�R SF7B�CK <br />USE20NE <br />HEICIIT IIMITATION <br />Off.ON$f <br />FEE <br />SUB TOTAL E <br />PEHMIT E <br />f`IIONE ST�tE LICENSE • <br />HEATING SYSTEM: I�I,GAS f l ELECTRIC f 1 <br />CONT�CTPF.RSON�NOPHOHENO. � / � <br />/ �-1 ` I� . 1 1 1 <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION 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 ORANTIN(i OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. tHAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY 10 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />XONTRA pRS LAW 79.2 RCW AND 298.200 WAC. <br />!f- af- 9� <br />sroN�tun o�te <br />CITY gU9iN655 LICENS[ NO. <br />NO. TYPE OF EOUIVMENT � FEE <br />A/C — AMNDLO UNITS — H.P. <br />HEAT PUMP <br />UNIT NEATERS — B.T.U. M <br />VENTILATION FAN <br />RAN6E HOOD <br />WOOD STOVE <br />METAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />6A5 RANOE <br />OAS PIPINO <br />SIOE SETP0.fN � PLIINCIIECK <br />LOT�qF.A V�G1Nf51fE FEES <br />IIYES IiNO BIIIIDINC <br />NO Of DWELLINp 52E Of BIIXi�TI <br />IINifS 1`LIIMpINb <br />OCCUP�NT LO�D BIISEMF,NT MFCIIRNICM <br />f1YES 11NO -- <br />�p�5� ADDIIIONM PI AN Ci�ff.N <br />om¢n <br />nFnc� <br />STp1E pUIIOMC $UfICII�I1f:E <br />rinNsnrrnovener CITYOFEVERETT runnr.wnnKc <br />LOCALSALES -- <br />����E TAX CODE IS 3105 TOTAL <br />--�— <br />PERMIT S <br />TOTAL FEE S <br />f[F �RFf.FIPTNO <br />