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APPLICATI� FOR CONSTRUCT"')�1 PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �C���� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB70 <br />❑ DEMOLITION ❑ COMBINATIO`NA p BUILDING ❑ MECHANICAL � PLUMBING O SIGN <br />PROJECT ADDRESS: � I � P��i�oltaG.II <br />(� ��f� .�is�, . — <br />OWNEN M�IlADD1iE55 diY !IP P��ONE <br />IENIWT MNLAD09E55 CITY IIV Pi�ONE <br />•RLPo�ECT OR DESIGNER M�II MDRE55 CIN 71P PNONE <br />.. _. � . n� � '� ___ _ �.�...i wA.i...�..�w...iLn <br />CENEMLCON1�TOp M11L�OOPE55 CIiY 71P PiIONE SIMEUCFNSE� <br />l0T <br />NVHN�NDSOU�PE <br />OF PROPf <br />_ EIOCN <br />TA7I ID. NUMBER <br />MVOLVEO <br />CWSTNUCTION LONi IENDER. �OOHE55. TElEP110NE NUMBER <br />PLUMBINti <br />NO. TYPE OF <br />WATER CLOSETI <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNORYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />TWO COPIE5) <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FHONT SETBACK AEAR SETBALI( S�OE SETBACK <br />USETONE <br />ME�611i LIMITATION <br />IOT�REA <br />NO OFOWELUNG <br />UNIIS <br />OCCUP�NfLO�D <br />VACANT SITE <br />❑YES ❑ NO <br />SIZE OF BIDGR I <br />❑YES ❑ HO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 9105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTACT PERSON AND PHONE 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 TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOflITY TO VIOLATE OR CANCEL THE PROVISION OP ANY <br />OTHER STATE OH LOCAL LAW RE6UUTIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TNIS PHOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR ORS LAW 1827 RC 296.200 WAC. <br />X� � i�/�T/y,� <br />SIGNATUPE O�TE ( <br />CITY BU5IHESS IICENS[ NO <br />MECHANICAL <br />NO. TYPE OF <br />NC — NHNDId UD <br />FORCFD AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVERS <br />RAN6EHQOD <br />WATER HFATEF <br />WOOD STOVE <br />MEfAL FIREPLACE i <br />FIREPIACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE S <br />P�ANCUEGKNuupEi�„ I�EF IAECEIPTNO <br />Ol➢I�INf. <br />P�IIMBING <br />MECH�NIUI <br />�UOIIIOH�L �l�N LIIF.GR <br />0�11Ei1 <br />$TA1E OUIl0�N6 SpRCP��6E <br />runur.vmnKs <br />TOTAL <br />