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APPLICATIC:� FOR CONSTRUCI.ON PERMI� <br />CITY OF EVERETT • BUILDING DIVISION <br />32C� CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOLITION ❑ COM8INATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: �� <br />� c� �= I�a,uc_ �v �_2�_T 5 <br />. .-.__.'"�.."� ���� Zlv PIIONE —.. <br />•RCNIECTOqDE51GNER I,W�AppqESS CITY )IP PHONE <br />GENEfUL GONTMCTOR MMI AUDRE55 CrtY z�p pnONE $f11TE ULENSE • <br />—� ... � <br />- -- --- ..... �ir rnvnc tiuTE LIGENSE � <br />MULlMGCONiR��TOR MMLI1DqiESS CIIY IIP PHOHE $TATELILENSE• <br />UESQIIlE WOqK ANO SIXUIRE FOOT�E W VOLVED <br />!lUN 6qS L�N�_ <br />anovoseo use w eutdrx� <br />�ak oEscnrria � ov Pnorea <br />LO7 BIOCN _ <br />I CGAS FUI`.�,�AcN <br />u�s�a��� F� <br />Yn 7�i ' O(l4 — lxJ-1 ' <br />CONSTRUCTION IOIW LENOER, AOORE55. TELEP/qHE HUTAEEq <br />�� <br />NO. TYPE OF FlXTURE Oq ITEM <br />WATER CIOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />GATHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL S <br />TOTALFEE S <br />HEATING SYSTEM: I�GAS ❑ ELECTRIC ❑ <br />CONT�CTVERSONM1DPFqNENp 1 � . <br />1 HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br />APPLICATION ANC �NOW THE SAME TO BE TRUE ANU CORRECT ALL <br />PROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINCi OF A PERMIT DOES MOT PRESUAAE TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br />CONTR RS LAW 1827 W AND 296200 WqC. <br />X _��� 1i�� I � ,.� -�� <br />SK�NATUqE D� E <br />CITY BU$�NE$$ L�CENSE NO <br />NO. TVPE <br />NC—AMNDLG <br />FORCED AIR SY <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVE <br />RANGEHOOD <br />WATER HcATER <br />WOOD STOVE <br />METAL FIREPLA( <br />FIflEPLACE INSE <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />` D(HAUST FAN <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />Fllpii SE7BACk pE�R SETB�LN SIDE SEiB�Ck PUN CBECN NUMBER fEF RECEIPT NO <br />USE ZONE <br />MEIGIIT LIMTATION <br />FlRENARM <br />LOT �RE� VACANf SITE FEES <br />❑YES ❑ � BUIIDMb <br />NO OF DWELUNG 51� pF BtDGRI <br />UNIfS <br />PLUMBING <br />OGCUPAN1lO�D BASEMENT MECN�NIG�I <br />❑YES ❑ NO <br />REASON AD��iION�� PUN CNf.LN <br />ou�en <br />aF�CpN <br />$TAIE BUIl01N6 SURCN��GE <br />�inNs�rraov¢oer CITYOFEVEREIT ruenr.wonKs <br />LOCAL SALES <br />o�iE TAX CODE IS 3105 TOTAL <br />