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APPLICATIQ`7 FOR CONSTRUCT. 1N <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, Wq g8201 • 259•8010 <br />❑ DEMOLITION <br />PROJECT ADDRESS: <br />❑ COMBINATION <br />BUILDING ❑ <br />�' � ��1�-L <br />PERMIT <br />� <br />❑ PLUMBING ❑ SIGN <br />l� S'a� >' <br />�RGMTEGTpppE51GNER MAIt�DDRE55 ��Ty <br />71� 1'110NF <br />GENERI1lCONTRAGTd1 M�i�AppqE55 <br />CIfY pip nnONE SGTEIICENSE� <br />��r�in�sn <br />zm <br />PIUMBINCCONTRACTOR MMLACDRE55 CIfY <br />ZI� PNpNE STATE LICENSE • <br />DWf u.i N� siNG E <br />LEWL OESG PTION OF PNppERTY (ypWN Br: <br />LOT � BtOCK _ <br />,.n... �.._... _� . • <br />CONSTNUCTION IOAN lENOER. ��OpE55. TELEPIIpNE NUA19(P <br />NO. TYPE OF <br />WATER CLOSE7� <br />BATHTUB <br />6 <br />TRAY <br />DRINKIN6 <br />SUB TOTAL 3 <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBRLK RE�R SETBACN <br />USE20NE LOT�REA <br />NEIGHTUMITATION NOOFpWELLING <br />UNIIG <br />LO W <br />REO'0 <br />SIDE SE79�CR <br />VAC�NT SIiE <br />rJYES O NO <br />SRE OF OIOGR.I <br />�`i6 S,F. 4v�ti <br />0�5[✓RENf/ <br />�Es ❑ NO <br />HEATING SYSTEM: �GAS ❑ ELECTR�C ❑ <br />CONI��t P[f150N ANO PMpNE NO <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED 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 SPECIFIEO HFREIN OR <br />NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONS7RUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS M E AND I COMPLY WITH THE STATE <br />CONTRACT W CW AND 296.200 WAC. <br />G <br />10 — � <br />D�1E <br />CIIY BU51NES5lICENSE NO. <br />UNIT <br />RANGE <br />GAS <br />1'UN CIIECK NUMp[� <br />O1111111NG <br />riuuoiNc <br />MfCN�NICnL <br />eOpIIIpNRI PIAN �RCCe <br />ou2n <br />suie nunoiNa suncrunce <br />C1TY OF EVERE7T runnr, wonKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />0 <br />SUBTOTAL <br />PERMIT f <br />TOTALFEE S <br />fEF O RECEIPiNO <br />'�! � <br />