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APPLICATIO'� FOR CONSTRUCT�N PERMlT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STHEET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION � BUILDING 'jJ ME HC� ANlCAL ID PLUMBING ❑ SIGN <br />/ <br />PROJECT ADDRESS:_ �� ( � 3� /�t� ��-- %1-- <br />OYMER MNL�DOFE55 Lltt 21� 1'I�ON[ <br />�►4t�tvu�nil S��-�"� 2ty02 30�1�it/�cW �P�IG.( G6o3b 35(0 24�5 <br />TENANI r � MNLI�OR[55 f r f.I1Y �� lIP PIOIF I� <br />ARGPoTECTORUESIGNER M�IIADDRE55 CIIY 7�� �HONE <br />— _ _ . _ . .�r� lA�i—�'i�3� <br />trtv S�r <br />MECH�HIC�LCONTRACTOH MMUDDRE55 Gn' ZIP P��ONE ST�TEUGENSE� <br />PWMBINGCONTR�GTOR MM��008E55 Cltt ZIP PIIONE ST�TELICENSE� <br />OF WOi1K <br />FOpTAGE1NVOlVEO <br />ov vnori <br />_ BtpCN <br />0 <br />CON57iiVL710N IOIN IENDEN. �DORE55, TELEf'HIX�E MIMBER <br />�.��`—� �"� °'" '�=-�"fE"r.� <br />!ZI � �-w...S_.ti. n i <br />CLOSET <br />SHOWER <br />WASHER <br />ROOR <br />— ' TOTAL <br />FOR OFFICE USE ONLY: <br />�RONT SETPACN REAR SEiB�fj �.m{ <br />-�� � 1.5 �,, <br />�5�`_z �oT��r, <br />HE�GNTLII'IT�TION UNIi�DWELLINQ <br />-/ � <br />NKLERREO'U RE�SON <br />IMREO'D RE��� <br />f,ONSI �'LANS�PPRQV�Y <br />— /.� OeIE 7 i �7i'J <br />S� <br />S <br />SIDE SETB�LN <br />S� <br />V�C�Nf SITE <br />HEATING SYSTEM: ❑ GAS ❑ EIECTRIC ❑ <br />GONT�CT P[RSON M!D PHONE NU <br />�..n� .ee��.i�.iL/ � i�Sl���y; <br />t" �A-+�TiN T7Q-�LM.\ �' � �t -a --� ... i-� _ <br />I HEflEBY CERTIfY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNGYI THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWt, AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COFAPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIhG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW FEGULATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV l'HE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIQN IS MAOE AND 1 COMPLY WITH THE STdTE <br />CONTqCCYbHS lAW 1827 RCW AND 296200 WAC. <br />QTV <br />NO. <br />PUN <br />FORCEC AIR <br />HEAT PUMP <br />FIREPLACE <br />RANGE <br />�'f�5 ❑ NO OUIIDING <br />Ol�.f � I V��,(U } pl11MOMG <br />i �.f .�a'iR�"� <br />15EMENf � � MEC��A��iC�L <br />❑VES 6�C <br />ADD�I IONA�. PI�N C��(.LN <br />on�en <br />SiAIE OUIl01Nf SIIRC1Uf1GE <br />CITY OF EVERETT runnr, wonns <br />LOCALSALES <br />TAX CODE IS 9105 io7aL <br />SUBT0IAL S <br />PERMIT S <br />TOTAL FEE f <br />rEF „ nEr.EmTNo <br />