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� <br />APPLICATI�.rd FOR CONSTRUC7 rON PERMIT <br />CITY OF EV[RETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f� DEMOLITION f 1 COMBINATION fl BUILDING �l MECHANICAL i 1 PLUMBING f 1 SIGN <br />PROJECT ADDRESS <br />/0.330 �� A✓•� tc�• ��E.t�.—T, l,Jh <br />OWNER MnReDOR[SS �ITv i1P PNON[ <br />�J ,� ,��J,rv ��a3.�,eon,� AJ� s�✓� %7. �,e y8� o/ �� a- 9�a D <br />MRII ADDRE55 <br />m.n wuncns <br />GIiY IIP <br />arv nr <br />cnv 7m <br />m�Ome <br />r�wr+r. <br />$tAT[ LIC[NSE � <br />.___......._.._..., .............. ,.,�....��..��o bii♦ iw �•iWrv[ tiiNF.UCENSE� <br />PWMBIHGCONiRAf,70R M4ILRUORE55 CITV 21P PNONE SIAIELICENSG� <br />COYiR�CT PRICE OF WOfIN <br />HEATING SYSTEM: f l GAS f 1 ELECTRIC � 1 <br />,eESCRIBE WORK At/O SOU�R�FOOTe E INVOlVEO � � �1` CONTACT PGRSON r1NO FnONF N0 <br />A <br />PROI`OSED!15E OF BUILOING <br />IEG�L JESCBIPTION OF PROPERtt <br />LOT BLOCK _ <br />� 0 /—.�... _ / <br />I <br />—0��7 - �j�—ri�7(�` <br />LOAN LENDEP. �ODqE55. tELEP11pNE NfIMqF.R <br />TYPE OF FIKTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />DRAIN <br />.OW PREVENTERS <br />ERVICE — BAR, ET <br />FOR OFFICE USE ONLY: <br />('RONT SETPACK PE�R SFTOACN <br />USE 20NE lOt�qEA <br />IIEIGHTLIMIil1TION NOOFOWELLING <br />uHirS <br />IYPEOFf,ON[T �PInNSAPPROVF.DOY <br />a <br />I HEFEBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7VPE OF <br />WORK WILL BE GOMPLIED WITH WHETHER SPECIFIEO HEREIN OIl <br />NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAIN REGULATINCa CONSTRUCTION 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 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827�iCW AND 296.200 WAC. <br />pnl[ <br />diV OUSINE55 LIC[NSE N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />NC — NFINDLG UN! i S— H.P. <br />FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATEFiS — B.T.U. M <br />CLOTHES ORVEF.S <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFEPLACE (WOOD BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SIDESETpACN P14NCIIGChNU OFp <br />VACRNi <ITF. EES � <br />IIYES fINO OURDING <br />SIZE Of O100/tl <br />PLUM[iING <br />BRSEMENT MECIIAWCAI <br />IIVES Ii NO <br />ADDI110`!�L PUN G�CGK <br />OtNER <br />$T�i[ OWIDMG SUnCr1AME <br />CITYOFEVERETT runiir.wonKs <br />LOCAL SALES <br />TAX CODE IS 3705 TOTAL <br />SUBTOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />rEr � aecarr No. <br />FEE <br />