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� ^ <br />APPLICATIO��� FOR CONSTRUCT�.�N <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />PERMIT ���� <br />BUILDING DFPARTMENT HEATING SYSTEM: GAS ❑ ELECTRIC ❑ —� <br />259-881 U <br />❑ OEMOL'T20N 'J COh'61NATION �BUILDING ❑ MECHANICAL ❑ P�UMBING ❑ SIGN <br />OWNER N�K�OORE'sS CITV 21P PlIONE <br />�✓�REtr �%us.,✓s ,dunloesry /4oi OPie,¢ t✓�.e�-rr wA �'flYo/ ao� �a58y'uZ <br />TEN�NT MI11lADDRESS CIiV 21P PHONE <br />ARCHITECTOROESqNEp IMKADORFSS CIT/ ZIP PMONE <br />DY�.xti✓ A�i/rrerrs imoa �rr �`�ro �vE�zr u�� f0ao/ aOG o�5f �ln/ <br />OENEMLCONTMCTOR IMKAODRESS CIT/ 21P PFIONE STATELICENSE� <br />�C' 3 <br />MECNAN CON7AACTOp MI1N.�DqiE55 CIiY ZIP PIIONE ST�TELICENSE� <br />C,IASSf. WpRI( <br />❑ NEW O ADDITION <br />IMIL MORESS <br />ALTERATION . REPAIR <br />� CONTRACTPRICEOFWqiI( 'T'.i.y.i�!.../ <br />DE9CRIBEWOIIKANOSWApEFOOTA EMVOLVEC <br />rAorweo use aF euwra <br />� <br />LEML OE9CPoPf10N OF PIIOPERiV (SHOWN BEL01 <br />LOT BLOG( OF <br />i <br />; <br />i <br />PROJECT A'1DIIESS <br />COPIES� <br />%3/0 -�,' -i`f"iC <br />TYPE OF fl%TURE OR ITEM <br />t KITCNEN SINK d DISP <br />� DISHWASHER <br />� LAUNDRYTRAY <br />� CLOTHES WASHER <br />� URINAL <br />� DRINK�NQ FWNTAIN <br />: FLOOR DRAIN <br />' BACKROW PREVENTERS <br />I ROOF DRAINS--RAINLEADERS <br />PERMR <br />TOTAL FEE <br />FOR OFFlCE USE ONLY: <br />�noaisEie�cK aE�ne <br />use za� <br />rvre a carrs. i <br />� <br />S�ZE OF BLOfl. <br />pCCUPANCY LI <br />RE�SONFON: <br />INTAI� BY <br />LOT MEA <br />J�T'1►� 'RH� <br />F��..��a�:,.aa <br />xo <br />NEIGMT LIMI7�710N <br />CIiV 21P PF10NE <br />CI DEMOLITION C 7 WOODSTOVE/FRPL INSERT 1.7 BUILDING REIOCATION <br />CONT�CT PERSON N1)p/p NDNE NO. <br />�.. � %�'_" /'C�nri� /1Jt/r.uL � A� .�.w✓ <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />a�-3�G� <br />i HEREBY CERTIFY THAT 1 HAVE READ AND EXANINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLET.ED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF S P PERTY TO PERFORM THE WORK FOR WHICH <br />APPLICA ON IS ADE, AND I COMPLY WITH THE STATE <br />CONT TORS LA 18.27/pQW AND 298.200 WAC.� <br />C/UW <br />A/�AIFiNDLO UNITS—H.P. <br />FORCED AIH SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />METAL <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPINO <br />EXHAUSTFAN <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />SPRINKLER <br />STATE PUILDING SURCHAROE <br />PUBLIC WORKS <br />TOTAL <br />� <br />S <br />.� <br />