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APPLICATIO" ' FOR CONSTRUCT. �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �C�✓��' <br />3200 CEDAR STREET • EVERE'TT, WA 98201 • 259-BB10 <br />i <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br />IENANT 4/Jt110piE55 GTV ZIP PIIp1E <br />�RG1NiCTp10ESIGNER MNlA0URE55 LITY 71P PHONE <br />PlU1AMNiCON7RACTOi1 MAIL�0011E55 CITY 21G PlIONE STATELICENSE� <br />OESCRIlE Wp11c �NO Sd1�RE FOOTA6E N1vOlVED <br />��'�/ ) �� /JGl r , <br />�uJ i�' ir� S fl C <br />�roseo use ov eu�arxi <br />�aK oescnrna+oc vnovEnr �s�awn ee�or� <br />wt xau a_ <br />� ��C'-D/X- <br />lENOER.l1U011E55. TELEPIqNE MMIlER <br />PLU�IMNf1 <br />NO. TYPE OF <br />WATER CIOSET <br />BATHTUB <br />pISHWASHER <br />t1A1NAL <br />BACNFLOW PREVI <br />SIN1f ISERVICE — <br />C:; <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />iRONf SETlI1L1( REM SETMCII SIDE SEtMCR <br />USEIONE <br />HE16HT UMTATION <br />n. n:rr:i:.r.: <br />FEE <br />HEATING SYSTEM: �'GAS ❑ ELECTRIC ❑ <br />. <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO dE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANrES GOVEHNING THIS TYPE OF <br />WORK WILI BE COMPLIED Wlhl WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR IOCAL LAW REOULAT�NO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF TFIIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />7���r�k-F��//�� �7/lI� � � � ^ �{C <br />510 ��� O�TE <br />CITY BUSINE55 LICENS[ NO <br />NC —NHNDlO UNfTS <br />FORCED AIH SYS1 EMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE (WIX <br />FIREPUCE INSERT (WO <br />GAS FlREPLACE / J'�S� <br />GASRANGE <br />TOTAL <br />f <br />S <br />PIIWCIIECNNUMBEP �fEF IRFCPPTNO <br />1OT11RE� VI�C�qT51TE rcw <br />❑VES ❑ � BUIlDIN6 <br />NO OF OMIELtINb 512E OF S100/f l <br />UNIT$ P�U4BINC <br />OLLUVM/TLOI�O l�SEMENT MECN�NIC�I <br />❑rE5 ❑ �M <br />RF�SON �W� ��ON�L MAN C�IF.CK <br />OINER <br />RE�S(X! <br />sreie eunoiNc sunc�unce <br />PUNS.�PAOVEO BY CRY OF EVERE7T PIIPnf. WORRi <br />LOCAL SALES <br />,,.,� TAX CODE IS 3105 TOTAI <br />FEE <br />