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�. �. " .��..,.�.y... <br />APPLICATIOr1 FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILOING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT Ai1DRESS: <br />/f���1,7��� oF_�._'��...,.�:�s <br />ONNER MMI�DDPE55 �IfY 7iP PIIOHE <br />.2y 1� L�1 esT Ma�i uF G� e,�' Pna3�',��'r,l 9��0 � :'fl-l�/"d -�S�-�5(� 3 U <br />IENANT Y�I1A0011f55 CIIY �I PI�ONE <br />ARCNITEGiOf1UE51GNER M�It�0�f1E55 CIfV )iP <br />CENEMILONIMLfOq M�I1�0�11E55 CIIY )iP l410NE SGIEt10EN5E� <br />/��ll� Y1'f�� <br />uECH�NICALLONT�CTOfI 1AAIL�D�f1E55 f.liY IiP I+IIONE SGfELItENSE� <br />PLVWINGCONiR�CTOR MAIL�DDRESS <br />� � -` tL <br />1'RiCE <br />rhstmet wvaK �No <br />IEG�L DESCRIPTION OF PROIM <br />l0T BLOCK <br />PLUMBING <br />wvaveo <br />BEtOw <br />�DORESS. IELEPqNE NUMBEfi <br />OF <br />BATHTUB <br />LAVATORY (WASH BA' <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOtINTA1N <br />FLOOR ORAIN <br />SINK (SERVICE — BAR. <br />FOR OFFICE USE ONLY: <br />pRpITSETB.�CR PE�R'FTBACK <br />USESONE <br />h :iGNT LIMIT�710N <br />�Or�nE� <br />CO�iES� <br />CtlY <br />HEATING SYSTEM: ❑ GAS 0 ELECTRIC ❑ <br />f.UNUCt Pf. i150N A110 PMONE NO <br />I IiEREDY CERTIFY THAT 1 HAVE READ AN(1 EXAMINED THIS <br />APPLICATION AND NNOW THE SAME TO �E TRUL AND C(1RRECT All <br />PROVISIONS OF LAWS AND OPDINANCES GOVEANING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIPIG OF A PERMIT DOES NOT PRESUME TO GIVE <br />i.UTHOHITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTNORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />AP?LICATION iS MAOE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296,200 WAC. <br />x �^%� 6�-t.L�� lYC'C�,CPr/%9G• <br />SI �NnE D�TE <br />CIIY pU51NE55 LICENS[ NO <br />i'.L•��ili3•73�•1�11:.'.T3: i i�3�� <br />�A/C—AMNDLGUNRS <br />� FORCED AIR SYSTEMS <br />i HEAT PUMP <br />' UNIT HEATERS <br />� CLOTHES DRYERS <br />RANGEHOOD <br />� WPTER HEATER <br />� WOOD STOVE <br />� METALFIREPLACE�WOf <br />; F�REPLACE INSEFiT (WO <br />� Gl�S Flq[PLACE <br />; GAS RANGE <br />� GAS PIPING <br />SUB TOTAL f <br />PERMIT S � <br />TOTAIFEE S ' <br />SI� SETO�CK <br />NO Oi OwEIUNG <br />UNi15 <br />V�CANI SIIF <br />❑YES ❑ NO <br />92EO�BLOGRI <br />❑�ES ❑ Np <br />SUBTOTAI S ; <br />PERMIT S —? <br />TOTALFEE f ! <br />ri�Hu�ecKr.uunrn I r[F � ner.r�rrr�o <br />nminn+r. <br />P1U401N6 <br />MECII�HiL�I <br />•DD�IiOr+el PI�N G�lCK <br />ou�[n <br />suic nunonm sunc�unee <br />serr oveoor CITYOFEVERETT nunur.wonn5 <br />� � J �` LOCAL SALES <br />l I- lH�• i i TAX CODE IS 3105 TOinl <br />FEE <br />� <br />