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^ � <br />APPLICATIO�. �OR CONST�iUCT1�N PERMIT <br />CITY OF EVERETT • BUI�.DING DIVISION <br />3200 CEDAR STREET • EVERETi, WA 98201 • 259-B810 <br />❑ DEMOLITION ❑ COMBINATION p BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />PROJECT ADDRESS: h I�G3 1/�I f-� �i„ I n:n i{ 7l�I <br />TENANT MA�LAppRE55 G�Y Z�P PI�ONE <br />�RCPoTEGTOi1�E51GHER MNIADORE55 CIfY p.IP p110NF. <br />GENER�LCONTRALIIXI MAILADDRE55 �ItY )IP PIIONE SIATEIICCNSE• <br />CONTR�LTO� i MMIADDRE55 CIiY ZIP P11pNE ST�TE LICENSE • <br />fIUMBINGCONTR�CTOR � M�II�DDRE55 <br />�1 <br />GONTRACi pqICE OF VlOfil( <br />DESCRIBE WORK �ND SOUARE FOOT�GE INVOLVEf <br />_i�li� �� � i i"�✓ -1^( <br />��� �, Ai� �'� �'nl _ <br />�u�5����,,�.� �� n���� <br />d�noroseo use ov e awo <br />LEG�I <br />tor _ <br />PARCELTA%ID. <br />BLOCK <br />CONS7RUGTION IO,V! LENDER. �pppESS. TELEPMONE NUMBEfl <br />WATER CLOSET <br />UVATORV <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PREVENTERS <br />CINKICFRVIf:F—RAH FT <br />SUB TOTAL <br />TOTALFEE <br />S <br />FOR OFFICE USE ONLY: <br />iRONTSETBAGIf R�ARSF.TBACK SIDESETB�CN <br />USEZONE IlO7�REA <br />NE�GHT UMI7ATION NO OF UWELLING <br />Un'If5 <br />OCCUP�NCY NO M S�MiES OCLU�ANTl0�0 <br />Gi10UP <br />FIRESPRINKLERREO'0 �FnSON <br />FEE <br />UCENSE • <br />HEATING SYSTEM: p GAS ❑ ELECTRIC ❑ <br />COHTAGT PERSON AND PMONE NO <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPIICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVEHNING THIS TVPE OF <br />WORK WILI 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 ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS lAW 1027 RCW AND 296200 WAC. <br />x JnA cUM�n'1 �-2��q C�Q, g- �-�W <br />SIGN� ,� ` ^ n ^ � O ��r� . � <br />C C �% � 1 L/ <br />CIfY BUSINESS IICENSC NO <br />NO. TYPE OF EOUIPMENT FEE <br />NC — NFiNDLG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />WATER HEATER <br />WOOD STOVE <br />ME7AL FIREPLACE <br />GAS RANGE <br />FAN <br />SUB TOTAL S <br />PERMIT f <br />TOTAL FEE S <br />P�ANCIIECKNUMBEfI � fEF � �FCEIPf NO <br />VeC�Nt SIfE FEES <br />❑YE$ ❑ NO O1111�INC <br />S�ZE OF BLDGRI <br />�LIIMOIN6 <br />BASEMENT MEG��ANIC�I <br />�YES ❑ NO <br />40DIIION�L PI�N CMCCN <br />amen <br />sme nunomc sunaance <br />CITYOFEVERETT runiir.wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOTnL <br />