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APPLICATi�..� FOR C�NSTRUC7.JN PERM�T <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 '���" <br />❑ DEMOLITION ❑ COMBINATION �UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ( <br />��a-�r.��G �i' l/�r s �zo S� �GcvcX'%Gy��o � �v 9�'xo� ��Gy�¢ <br />TEIUNT MNLAOOHE55 GTY ZIV FNONE <br />ARCIIREC/T�OR DESIGNER /� /� M�IL �DDRGSS GITY lIP PMONE <br />F I �/�l �V C V�/ <br />GENE TR�GTOR M/Jl I�ODRE55 GTY IIP P110NE SfATE UCENSE • <br />�� <br />CONT T PPo W011N <br />�/,!/�jL�.t%t� / GL/ �/i/PAUAiI'f.*i/I/�' HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OE NqRI(ANDSOU�REFOOTK.EINV VE� -�CON�CTFERSONANOPHONENO �/ �/�, <br />LO7 <br />O/ <br />BIOCN <br />�� Q <br />CONSTRVCiION LONI �ENDER. �DDRE55. TELEPHONE NUMBER <br />TYPE OF FlXTURE OR <br />BATHTUB <br />DISHWASHER <br />I.AUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />TOTAL S <br />FEE <br />� TOTAL FEE S I _� <br />FOR OFFICE USE ONLY: <br />FIiONT SETBALN REAR $ETB/�CN SIDE SEiB�LK <br />USE ZONE lOT AREA VAC� IT SI�E <br />❑YE'i ❑ NO <br />HEIGHTLIMITATION NO.OFDWEUJNA -1ZEOFBIOGRI <br />UNIfS � (� I � <br />IO�D B�SEMENT J/�" <br />„ ❑YES O NO <br />IMREO'D RE�SON <br />1J <br />f,'NST� PL�NSP i�OVE�BI <br />%1�/ <br />DRTE Z • I 2 - <br />' .-�7 � � I v/ 7 _ <br />I HEREOY CERTIFY THAT I HAVE READ AND EaAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOiiK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF; <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATIN(3 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />ii:YNER OF THIS PROPERTY TO PERFORM THE WORK i•OR WHICH <br />APPLiC�ATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT FS LAW 1827 RCW AND 296200 WAC. <br />X �.�A .twi �///�/%il.� Z� I% �Q C'J <br />5 D�TE <br />CtTY BUSINES$ LICENSE NO. <br />MECHANICAL <br />NO. TYPE OF ECUIPMENT FEE <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WOOD STOVE <br />MEfAL FIREPLACE <br />PIPING <br />\UST FAN <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE E <br />PUNCNEC�'y�E�� I FEFnO. �` I RECEIPT NO <br />1 Y � <br />OWIOMb <br />PLIIMOING <br />MECIIRNICRL <br />FOOIIIONAI. PLAN LHf.CN <br />OIIIER <br />STAIE 9UILOINC SIIRLNRRGE <br />CRY OF EVEREIT ruour, wonKs , <br />LOCAL SALES <br />TAl( CODE IS 3105 7oTAL <br />�3 <br />� <br />