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< �- APPLICATIO�1 FQR CONSTRUC� �ON PERMIT/ <br />CITY OF EVERETT • BUILDING DIV!SION VC� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 � <br />f7 DEMOLITION f-1 COMBINATION fl BUILDING f7 MECHANICAL <br />rl PLUM8ING fl SIGN <br />T ADDRESS <br />Z U z S /'7/�ir✓ ST, .Ei��c�,p� �i9. £r�.o 3 <br />, MRILADORE55 QTf ¢IA PHONF,� S� — CsS �ZG <br />/C/ � • _:l�f-_5" % .j � -�Y S S� �'^'/�'v�' ��.,� .� ��F�r, , i. <br />OGSIGNER <br />/ <br />� ZiP FHONE <br />� lIP PHONE <br />n c _. _. <br />GEN.?fiPICONJ/fqCTOR MAILAD�RESS - � �IfY 11 P�IOPlE` 51ATE1 -NSE� <br />C/ <br />�'EGANICAICONiPACTOR MAIIAD�RE55 CiTV LP PIIONE ST4tEUGENSE+ <br />/ <br />��'a.cai�v.so � s— <br />CONI RACT PRICE OF WORK <br />UESCRIBE WORK ANO SOO�tFE FOOTRGE INVOLVED <br />LEGAL DESCRIPTION OF PPOPI <br />LOT�� BLOLN <br />�:a <br />ARACN TWO COPIES� <br />P�RCELTAXI,D.NIIMBEP <br />GONSTRUCTION LO�N LENOER. ADDRESS, TELEPHONE NpMBEH <br />NO. I TYPE OF <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASIi�R <br />UHINAL <br />— BAR. <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE l3SE ONLY: <br />FR04T SF'i1{qCN � REAR SET9ACK <br />zo Zo� <br />Uu^EZUNE LO1/.REA <br />� � J o 066 <br />HcIGNTIIMRAT10N � NOOFOWELLIN3 <br />�jp� UMiS � <br />2 <br />OF <br />�,� <br />STRTE <br />HEATING SYSTEM: �l GAS j'QELECTRIC I-1 <br />�ONTACT PERSON FND PNONE NO. <br />%Uf/�t/ G . GL�37 � Z� � : <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROYISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <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 REGULATING CONSTRUCTION OR THE <br />PERFOFMANCE 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 />CONTRACTORS LAW 1827 RCN/ AND 296200 WAC. <br />CITY BOSINE55 LICENSE N0. <br />NO. TlPE OF E�UIPMENT <br />A/C — A/HNDLG UNRS — H.P. <br />FORCED A�R SYSTEMS — B.T.0 <br />HEAT PUMP <br />/ UNITHEATERS—B.T.U. M <br />�' CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />� WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE fWOOD BUF <br />RANGE <br />PIPING <br />1U5T FAN <br />SIOE SEi9RLK PLAN CIIECK NUMU[P <br />�ys' � �t o � <br />vacarut;ire FEES <br />nves yrr+o ounoir+r, <br />)PBl rtl <br />Z f LIJINN .� p�pM91NG <br />9 S.F G� <br />BASEM�E�NT VECH�NIC�L <br />Ff9E5 1� n0 <br />noonior+ni. �inN a+ecrc <br />Oi11E(i <br />$TRE OUII�INC SURCIIARGE <br />CITY OF EVERFTT ruoi.ir, wonres <br />LOCAL SALES <br />TAX CODE IS 3105 70TAL <br />'S <br />3U8 TOTAL $ <br />PERA;IT $ i <br />_ TOTAL FEE S J <br />FEE RECEIPT 60 <br />3 <br />J <br />� <br />