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APPLICATIO.d FOR CONSTRUCT.JN PERMIT�w%� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR S'TREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION Cl COMBINATION ❑ BUILDING j�j' MECHANICAI ❑ PLUMBING fl SIGN <br />PROJECT ADDRESS 5-� /� � � h /f� � �/�� j <br />�y /J <br />. <br />OWNER MPILFDDRE55 Cltt 21P PIIONE <br />'F'Jb.� — •w ,� 190��'�}�•Ctr�.`3•4�--._56C3Ce �'}rs(o-��43'C <br />�fEN�NT M�I:ADDRESS CI 21P VHONE <br />�PS 16f.I L.�ty17� � � �S � ^ bs �j 1 <br />ARCMITECi OR �ESIGNER MAIL AOURESS CITY ZIP PHONE <br />� ._ . —.- �.l:_�� �n+t - 2iio2 -3a'�+4+�ti., 3wiH�.� 9.Q�a''�� '7S(o 2s.�i� <br />GENERFLCCNTRAC MAILRDORE55 Cltt � PIIONE STATEIILENSE� <br />�+.� ,�,�. 5N �• ''�'S �t-�► + i t <br />MEGHANICpLfANTiiRCT MAILA URE55 CITY ZIP PHONE STPTELICENSE� <br />PLVMBINGCONTBRCTOR MAIL�UDRESS dTY ZiP PHOkE STATELILENSE� <br />LOT <br />PARCEL <br />WORK AND SOURRE FOOT�GE INVOWE� <br />BLOCK <br />LONSTRUC fIOH LO�N LENDER, ADDRE55. TELEPHONE NUMBER <br />NO. <br />8 <br />II:1S/ <br />flXTURE OR ITEM <br />FOR OFFICE USE ONLY: <br />fRONTSETBRCK REARSETB�CK <br />USE 20NE <br />MEIGHT LIMITATION <br />�or�n=n <br />NO.OF OWEWNG <br />UNITS <br />OCCUPANTLOAO <br />REASON <br />HEAl1NG SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTRCT PERSON AND PNONE NO. <br />I HEREBY CERTIFV ?HAT I HAVE REAp AND E%AMINED THIS <br />APPLICATION AND NNUW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHEP 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 GONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE NORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE °TATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />la'a�-�� <br />SIGNATURE OATE � <br />CITY BU�INEES LICENSE NO. <br />HEAT <br />UNIT <br />i � GAS <br />' GAS <br />� EX.H� <br />� <br />� <br />� <br />$ ' <br />� <br />$ � <br />$ 1 _ <br />SIOE SETBRCK PIAN GIIECK f!U <br />I f1YE5 I7 YO <br />SIZE OF BIWRI. <br />❑YES ❑ NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />OF FIXTURE OR ITEM <br />.G UNITS — Ii.P. <br />SYSTEMS—B.T:J. M <br />BUILDING <br />PWMOIN3 <br />MFCIIRNICRL <br />ADDIPONAI PLAN CNECN <br />OTNER <br />STATE BNLDING SURCHARGL <br />PUBUC WORKS <br />TOTAL <br />— B.T.U. M <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FEE RECEIPT ND. <br />VALUATION FEE <br />�'l � <br />