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APPLICATIG� FOR CONSTRUCT �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECMANICAL ❑ PLUMBMIO ❑ SKiN <br />PROJECTAODREBS: �� �y-/6/�L�in� f� <br />prn�n wu��od�ss arv zm vHowe <br />.1/�7J�--ti — <br />MLM7ECTOPOE5�6NER �w�ooness cirv �in v� <br />,l�iG��. /i.�.�� eo�srnc c.r_srr�.. 9Fu-a= 33y--�.zoz iYo.-r�i�yco <br />penEpKcor�m�c wn�oor�ss cnr im v�ar� �utEi��+s�. <br />MEd1ANIC11l CdRMCTOR MNL AODIIESS GTY IIP PIIONE 5Tl1TE LICENSE � <br />PLUIIlRIGCpNiR11CTOR NM1100f1E54 C�1Y 21P PIIp�E STATELICENSEI <br />�� <br />W011lf /iM SOUARE FOO7iWE NVOWED <br />L� <br />lor �_ xodt �_ <br />Nlv ;Xo Z- <br />�g T�1I I.D. M111ER <br />S-3��-Gr�.�"',oa/ -.�c06 <br />OON6IRIIC110N ldW lENOER.110011ESS. iELEP110HE M1MlER <br />[a��::T7�1: <br />SMIK <br />SUB TOTAL <br />PERMIT <br />FOR OFFICE USE ONLY: <br />F110N. SE.ML�� REM SE1MC� , <br />5 <br />USEZONE � � IOTIWEA <br />.. <br />�aNr u►�una�� / � � a owewra <br />�oro <br />HEATINO SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTIICT PER90N I1NU Rq1E NO <br />I HEREBY CERTIFY TMAT 1 HAVE REAO AND EXAMINEO ThIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br />PROVISIONS OF LAWS AI� ORDINANCES OOVERNIN(i THIS TYPE OF <br />WORK WILL BE COMPLIED WI7H WHETMER SPECIflED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT OOES NOT PREBUME TO 61VE <br />AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY <br />O7NER STATE OR LOCN. LAW iiE0UU1T1NQ CONSTRUCTION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />ONMER OF THIS PROPERTV TO PERFORM THE WORK FOR NMICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTMCTORS LAW iB27 RCW A 298.200 WAC. <br />�� 2�lL.�S � �7-/S =�6 <br />/ pT'lU91HE55 LICENSE NO. <br />MECXANICAL <br />FEE N0. TVA <br />� MC—MNipl. <br />' FORCED AIR S <br />i HEAT PUMP <br />SIDE SFTl�CN I � <br />S <br />V�GWT 9fE <br />❑YES 0 NO <br />s�� or xoari <br />�7� � F <br />❑YFS O'� <br />Ci.OTHES DRYER: <br />FiAN(iE HOOD <br />WATER HEATER <br />NlOOD STOVE <br />MEUL FIREPLACE <br />FIREPLACE INSERI <br />(iAS FlREPLACE <br />OAS RlWaE <br />(iAS PIPINO <br />EXHAUSTFAN <br />PL1W d1ECK M1IABEP <br />BULONNi <br />PIUMBIN6 <br />1AECNNIIC�L <br />�ODIIION�I'R�N CHF.CIc <br />O7NER <br />STAIE BNlDIN6 SIIRCMI1fGE <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />/�` RECEIPT NO <br />� ` Ji �� <br />VALUAiION I <br />�3 —1�� / <br />CITY OF EVERETT ruei r vron�s ' <br />LOCAL SALES �" <br />TAX CODE IS 9105 TOTAL �� J U <br />