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- , <br />APPLICATIOr� FOR CONSTRUCTIVN PERMIT <br />CITY OF EVEflElT • BUILDING UIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOLITION O COMBINATION ❑ BUILDING L MECNANICAL � pLUMBING ❑ SIGN <br />PROJECTADDRESS: _ � ,�,,,�� li_S (.�GN,� - <br />lENlWT 4qL�0IX1F.55 f.IIY )ip <br />ARCMTECf pi0E51GNER n M�II Af%111E55 � GIIY )II• <br />4 �� iu►vl� 5 �� i -r�.�, �L�no�•cQ_ wt� s�'s�3'�- 7 �5-6Y�yDnYrv�ANovy��, <br />6ENEf1 Cq1iRl1GIOR MNL�Wf1 5 CIIY lll• PiIUNC SIqEIICENSE� <br />MECNAMC�ICONTR�CiOR M�IUODnE55 C�tY ]n•-"' PIIONE <br />S7aE UCENSE � <br />PLUMlkq�q�IR�tOR MML�OORE55 CIIY tm PupNE SUtELICENSE� <br />P:l <br />DESCRISE WORN �IA $qJARE f00T�0E INVOIVED <br />Ct� <br />ior e�oc� or. <br />vu�i ux i o. wi�n — <br />COM91rM1C710N lON! LENOER, /�ppRESS. IELEPIIplE MIMBEfI <br />1i0• TYPE OF fll(TL <br />WATER CLOSET (TOILE <br />BATHTUB <br />UVATOqY (WqSH BASI <br />SHOWER <br />KItCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRV THAV <br />CLOTHES WASHER <br />UHINAL <br />DHINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKROW PREVENTE <br />SINK (SERVICE — BAR, <br />FOR OFFICE USE ONLY: <br />iNp7T SETBACN NEM 3FTBACN <br />USE IONE <br />NEIOHT U W f�TION <br />FlRE <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />IIEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />C(Nll�(.t pCt15D11 ANO PIIONE NO <br />I HEREOY 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 WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br />coviesl NOT. TlfE 6RANTING OF A PERMIT pOES NOT PRESUME TO GIVE <br />MITHORITY TO VInLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STA�E OR LOCAI. LAW RE6ULATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WF71CH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 27 RCW AND 296,200 WAC. <br />X � 3' Z�-/7, <br />SHiNIUUpF OAIE <br />CI7Y flU51NE55lICFNSE !q <br />MECIIANICAL <br />FEE NO. TYpE OF EOUIPMENT FEE <br />— .. : A/C—MiNDLOl1N1TS � <br />; FORCED AIR SYSTEMS <br />� HEAT PUMP <br />' UNIiHEATERS <br />� CLOTHES DRVERS <br />WOODSTOVE <br />METAL FIR�PL <br />GAS FIREPLACE <br />GAS f7ANGE <br />EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT f <br />TOTAL FEE S <br />SIDESETP�CK If`I�N�II[f.RM�u11ff1 � I(Ef InECEIPTNO <br />IOIARE� VACANISIfC FEES <br />❑YES ❑ Np <br />OIIIIUING <br />NO Of pWE�UNp 512E OF BIOb/f I <br />IINIfR <br />PI114pIHC <br />OCCUP�Nf IO�D B�SFMENT MEf.11�HIf.M <br />❑YES O NO -- — <br />I1fA50N — ApUIIION�I P�ANC�IICk <br />omrn <br />RF�G(y� ___ <br />51�1 G 01111 bIN6 5� Iflf.lUll(iE <br />vinNs �rnnoveo ov CITY OF EVERETT runnc wonas <br />LOCAL SALES --- <br />o�rE TAX CODE IS 3105 TOTAL <br />