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APPLICATIC J FOR CONSTRUCT JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•BB10 <br />❑ DEMOLITION ❑ COMBINATION �'BUILDING �, MECHANICAL �� PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 7�� � 3q1� /� � J <br />t/�/����Z/�/ �J 1��31'SXK � ,�..—�'�n:� ,.�i� 9c��,._ ��,v ,,. . _ <br />•Np SOV�RE FOOTA�E INVOIVED <br />'J <br />LCT _ �/�' BLOCK <br />� <br />CONST.IUCTION IOAH tENDER, ApW�E55. TEIEPHOVE NW BER <br />i r�v111e11Rs <br />� NO. fYPE OP �p(TURE OR ITEM <br />� ....rr., ,.� ,..,..' '--" -- <br />CLOTHES <br />V <br />� <br />� <br />SUBTOTAL E <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />iRONTSETflACK _ pEAR SFTB�CR <br />�.ry <br />� �� � . <br />u5E20NE lotnnFn <br />�-� �`j O <br />HEIGNiLIM1iATI0N NOOFOWELLING <br />8 � UNIIG <br />OCµVP�NCY ND pf51MnF5 OCCUP�NILO�U <br />—N I ontE <br />cirv <br />0 <br />2�P VIIONE ST�tE UClNSE � <br />HEATING SYST�M: �GA� ❑ ELECTRIC ❑ <br />CONT�CT Pf.R50�ND PNpryE NO f 1 <br />i S3� �� r� <br />I HER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVI:�IONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETIIER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT pOES 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 AUTHOFIZED BV THE <br />OWNER OF 1HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 196200 WAC. <br />x ���� ��/� <br />SIGN�TURE/ � �OAIE <br />CITY BUSII. 55 LICENSF NO <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />A/C —lVHNDLG UNITS �— <br />FORCED AIR SYSTEMS � <br />HEAT PUMP � <br />UNIT HEATERS � <br />'J�/ATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE � <br />FIREPIACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />SIpESEiB�CK Pl�NC11GCNNU4pff1 <br />" � 3� 7.�,3 <br />/o r G <br />WC�Nf SIIE FEES <br />�1'ES ❑ NO <br />nunowr. <br />x a�ocrt <br />-J S�. C�ou.4 b rwumtic <br />s.F. cnan � <br />BASEMENi MEpIRNILM <br />❑YES �p <br />A�DtlION�L Pl �N CIICCN <br />on�en <br />sreie ounoir+c sunc�unne <br />CITY OF EVERETT runnr,wnn�s <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL E <br />PERMIT S /�� <br />TOTAI FEE E <br />f[F��` � flFf.fIPfNO <br />�X/Jr � ` <br />VALUATION FEE <br />�2 �v2 7� <br />� � <br />