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�. <br />APPLICATIO►,. FQR COIdSTF3UCTIvN PERMIT <br />CITy OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DE�IOLITION p COMBINATION �I BUILDING ❑ MECHAWICAL ❑ PLUMBING ❑ SIGN <br />PROJfcCTADDRESS: CI�[GS C�io,R-(-nr�� I�ln„ F��r�.n+l. �.11� <br />� <br />� <br />�a <br />s�355- 33yC"� <br />VE <br />�� s) 3sa-s�n(� <br />JE <br />s-] a s� :a i� 3 <br />JE �C'U <br />-4�— , i i �sj C�ixs- � t� s a- 30� <br />�E $iATE IICENSE � <br />.-�-••^••-^���^•^••�•�^ -�••^���_�� ia�r tn• vnONE STATELICENSE/ <br />PLUM,�B{ING CONTRACTO{i M�ILADDRESS CITY IIP PHONE STATE LICENSE • <br />YP(p5o5. )y <br />CONTR�CT PRICE OF WORN <br />NEATING SYSTEM: ❑ GAS ❑ ELECTRIC � <br />DESCRIBE WOqKAND SOUFRE FOOTAGE INYxVED . CONT�GT PEHSON �NO PNONE Np <br />S <br />OF BUILDING <br />LOT BLOCN <br />cor+srRucnow <br />PLUMBING <br />seww on <br />_ Of_ <br />oG7 o�v <br />'iELEPHONENUMBER <br />TYPE OF flXTURE OR 17'EM <br />WATER CIOSET (TOILETI � <br />UVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />DRINKING <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ET <br />FOR OFFICE USE ONLY: <br />FRONTSETB�LI( PEARSFTBALN <br />USE20NE <br />IIEIGNT LIMITATION <br />Np <br />�� <br />SUB TQTAL <br />P'eRMiT <br />TOTALfEE <br />S <br />SIDE SETOACK <br />FEE <br />I HEREBY CERTIFY 'fHAT I HAVE READ AND EXAMINED THIS <br />APPIiCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVI517NS OF LAWS AND ORDINANCES GOVERNIKG THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />I:ONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />x 1. Lc.� �'�Lc.e%x„�.l�.- i� /8 - 5'7 <br />5(GN�TURE O�TE <br />�l FS I l� O l i� (� �l Z- � Ei^� 1 <br />CITY BUSINESS IICENSE NO. <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />; FOflCED AIR SYSI <br />� HEAT PUMP <br />' UNIT HEATERS <br />i CLOTHES DRYER: <br />� fiANGE HOOD <br />; WATER HEATER <br />i WOODSTOVE <br />� METAL FIREPLACE <br />; FIREPLACEINSEHI <br />� GAS FIREPLACE <br />; GASRANGE <br />� GAS PIPING <br />SUB TOTAL S <br />TOTAL FEE E <br />PUNCIIECKNIIMflGR I fEF I �ECEIPTNO <br />� ���� <br />IOT�REA V�C�NISIfE FEES <br />OYFS ❑ NO pl➢tJiNG <br />NO Of DWELIING SIZE OF OLOGRI ' — <br />UNIiC / ' � � PIIIMOING — <br />lD <br />OCCUPANf LD�O 3a�J B�SEMEN7 MFC11nNICnI. <br />�, ./.�Sn c l ❑YES NO <br />REASON A�DI IIONRI. PI �N C��[CK <br />A¢kq sr/', ot��en <br />RE450N <br />�� S r� STATE BNIOMG SURCIInfiGE <br />i� <br />PLANSA noveoor CITY OF EVERETT �11911f, WOf1NS <br />� LOCAL SALES <br />on,F 7-�P> _ 9'7 TAX CODE IS 3105 io7a� <br />H <br />ov <br />