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APPLICATIO�J FOR COI�lSTI�UCTrJN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 982ot • 259•BB10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PpOJECT ADDRESS: iQ(o �y,T��� 1 [� � -------- <br />(IVMF{1 <br />MNLAODRE55 <br />cm rm PIION[ <br />GENE��ICONTp�CiOfi MMLAOORE�S GtY ]��' ��IUNE GI�IEtICENSE� <br />MECNANIC�I CONTNACTO{i MIJL ACORESS f.ITY 7iP P110NE STATE UCENSE � <br />�47e�s7Ca, nx�Lt4;�+is.�-(�Z9 i/75a�5E,Sv.nho..wsh�Z��-0'� </(07- �ro7 Ann�ex;xne,0'�IC�u <br />PLUMBINGCON7PACiOR M�IIADORE55 CIIV IIP PHONE STATELICENSE• <br />DESCWBE <br />�or <br />oc won� <br />.\ND:OUARE FOpiKiE INYOLVEO <br />_. ._ n . _ <br />OF <br />eixK <br />CONSTRIICTION LOIW LENDER./�WRE55. TELEPHONE NUMBER <br />NO. � TYPE OF fl%TURE OR ITEM <br />WATER CLOSET (TOILEn <br />LAVATORV(WA', <br />SHOWER <br />KITCHEN SINK ! <br />DISHWASHER <br />UUNDRY TRAY <br />CLOTNES WASM <br />URIAAL <br />ORINK:NG FOUI <br />FIOOR DRAIN <br />BACKFLOW f RI <br />SUB TOTAL <br />� TOTAL <br />FOR OFFICE USE ONLY: <br />FRONT SETBALK REAR SETBALN <br />USEZONE IOTARE� <br />HEIGMTLIMITATION N!1 OFUWE�LING <br />UNIIS <br />pC�P�NCY <br />o�re <br />IIEATING SVSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />conur.r rcnsou �nn r�wNe r+o <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PFlOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOHK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE (iRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTFIER STATE OR LOCAL LAW REGULRTING CONSTRUCT�ON OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONlRACTORS LAW 1827 RCW AND 296200 WAC. <br />X C� �/J �,��v.....�_ <br />swNerune ' oere <br />GTY BUSINESS IICENSC NO <br />FEE NO. TYPE OF EOUIPMENT <br />� A/C—AIHNDLGUNITS <br />� FOPCED AIR SVST[MS <br />� HEAT PUMP <br />� UNIT HEATERS <br />S � <br />EE E ' <br />SIDE SETBICK <br />V�C�NT9fE <br />❑YES ❑ NO <br />512E Of 9lOGR I <br />tlASEMENT <br />❑YES ❑ NO <br />CITY OF EYERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />WATER HEATt <br />WOOD STOVE <br />GAS PIPING <br />EXHAUfiTFAN <br />PIAN GIIFCN <br />p1111b�NG <br />ri ur�nu+c� <br />Mrr.im�ncn� <br />pppl I IONAL 1`I AN G �f GH <br />n111f11 <br />S1AtE OIIIl01N6 $II�iC11411GF <br />Pilflllf, WOBN9 <br />TUTAL <br />SUB TOTAL S <br />PERMIT E <br />TOTALFEE S <br />rEF nEcemrNo <br />FEE <br />