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APPLICATI�.M FO�i CONSTRUCI iON PERMIT �"}�. <br />CITY OF EVERETT • BUILDING DIVISION �/� <br />3200 CEDAR STREET • EVEREIT, WA 98201 • 259-BB10 ����•"' <br />❑ DEMOU710k ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLURIBING ❑ SlGN <br />PROJECT ADDRESS: <br />uluLMdlEsS <br />:�S`1 • <br />tia wrove <br />�RCPoTECT Oi10E51GNER M�II AODRESS Cltt liP PHONE <br />GENEMICONTMCi0i1 MNUDDRESS CIIY IiP PIIONE SGTEIICENSE/ <br />MECNMJIC/�LCONTMCTOR MI11lADqiE55 LIT' ZIP PHONE STA7ELILENSE• <br />/-v�- ' S�'�� SIr� P.4.3�F ISO4 �✓PrE'H 98206 ,7i1-3)�� C✓L2Ca1-JI�t1I(� <br />PLU ' CONTR�GTOR � M�IL�OORE55 Cltt Z�P PNONE S7ATE IICENSE � <br />pF NqRN <br />LOT BLOCN <br />PMCEL VX 10. NVMBER <br />GONSTfiVCT10N IOMI lENOEP <br />.i� (NwY/r ,'i <br />OR ATTACN TWO COflES) <br />TELEPIqNE NUMBER <br />TYPE OF FlXTURE <br />CLOSET (TOIIEn <br />SHOWER <br />KITCHEN SINK 8 DISP <br />UUNDRY TRAY <br />CIOTHES WASHER <br />HACKROW PREVI <br />SINK (SERVICE — <br />FOR OFFICE USE ONLY: <br />FRONTSETBACk PEARSETB�CK <br />USE ZONE <br />HEIGN7 LIMIT�TIUN <br />OCCUPNlCYINC M <br />GNWP <br />SUBTOTAL f <br />PERMIT S <br />S�OE SETBACN <br />HEATING SYSTEM: L�GAS ❑ ELECTRIC ❑ <br />CONT�CT VERSON �NO �P or�F NO <br />��a iPr2,rr. 1.. 2S'2 -3 I I N <br />I HEREBY CERTIFY THAT I HAVE RFAD AND E%AMINED 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 �RANTING OF A PERMIT DOES NOY PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6UUTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED 8Y THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />COkTRACTURS lAW 1827 RCW AND 296200 WAC. <br />����� ����� <br />x <br />SIGN�TUR D�TE <br />CITY BUSINESS LILENSE NO <br />NO. I TYPE OF EOUIPMENT I FEE <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />GAS PIPING <br />IXHAUST FP <br />SUBTOTAL S <br />PERMIT f <br />TOTAL FEE f <br />PUN GIIECN NU1ABCi1 /'1 I�EF � nEf.EIPT NO <br />tOT�REA V�CANf51iE 1'CCJ <br />OYES ❑ � BUILDING <br />NO Oi DwEL4NG S�ZE OF BID:Jf.I <br />UNIIS P�IIMBING <br />OLCUPANi LO�D BASE'IENf MECIUNIC�L <br />❑YFS ❑ NO <br />PE�SON ADDIIIONq. M �N C�IFCR <br />Ot11E11 <br />RE�50N <br />STAE OUIIOING SIIRCIIApGE <br />PLdNSAPPROVEDBY CRYOFEVERETT �UNIif.WORNS <br />LOCALSALES <br />n�iF TAX CODE IS 3105 TOTAL <br />