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c <br />APPLICATIG./ FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �rC� <br />3200 CEDAR STREET • EVERETT, WA 9820t • 259•BB10 <br />❑ DEMOl.IT10N ❑ COMBINATION ��, BUIIDING /❑ MECHA�jIICAL ❑ PLUMBING Ci SIGN <br />PR ECT ADDR�s S: ��.%� � �1 ��('i ���f�. !'�A i�"<' �'�`- <br />.Gc�.e- KF�"� ��.��ir� ---- <br />qy�q 1AMl/�DD11E55 LIiY II1' i'NONE <br />7EIUNT MULI�DDf1ES5 C!:Y <br />MAII ADONE55 � <br />� ��,! � �/-�c<,/.. !(c� ���i;� J)l <br />MAIIADDRE55 CIIY 1�� <br />ri�one <br />�f3531,�-�� l_Y"✓r�s� <<,,, <br />MEq1ANICQCONTR�CTOR MAILAD�RE55 QiY 21f' PIIONf. STREUCENSE� <br />%U1RMM>CONTR�GTOR M�iI�DDRE55 CItY ZIP PHONE STATEUGENSE� <br />�au <br />ior _ <br />:��::.::r.� <br />e�ocic / / <br />INVOIVED <br />Sit� `) (i� i��� -�C�'f L/�N� <br />� (',pISTRIICTqN lON1 LENOER.IIDORE55. 7ElEPNOME NUMBEN <br />�� <br />Ih�. TYPE OF FlICTURE OR ITEM FEE <br />WATEH CLOSET (TOILEn <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DIuHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOR DRAIN <br />� SUB TOTAL E <br />PERMIT S <br />TOTAL FEE S <br />FOR OFflCE USE ONLY: <br />iHONTSETPACR AE�R SF.T&�CI( SIDESEfB�Ck <br />ZU O � j <br />USE Z lOT AnE� V�C�NT SI1E <br />�� I O� pYES <br />IIEIGNTLIMITATION NO_Of�WEILING S�IEOFBLDGRI <br />o�rE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />f.ONT�CT VERSON �NO �HONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 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 WIIL BE COIdPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATc OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRIICTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW ANU 296.200 WAC. <br />/l . 9 /� <br />X Y /i'i//�r!'� � ��%%' � JL/ Y � <br />SIGN�TIIRE O�IE <br />CITY 9USINESS UCENSG NO <br />EOUIPMENT I FEE <br />rv�. — rvnn..iv v�.� �.. <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />GAS <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE E <br />PUN CIIECN NUwPf� � rec� ��� ����j' � Qecrm � <br />X' nO nunnwr, <br />� �u� PlUM01NG <br />MENI � / IIFCII�NIGI <br />❑�ES O�� <br />— RDDIIIONRIPUNCH(GN <br />O�H[P <br />ST�IE pl11lOMG $IIRCIIAR(:[ <br />CITY OF EVERETT runur. wonKS <br />LOCAL SALES <br />TAX CODE IS 9105 TaTAL <br />� '� <br />