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APPLICATION FOR CONSTRUGT�JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f� DEMOUTION �l COMBINATION fl BUILDING I� MECHANICAL �� pLUM81NG ( 1 SIGN <br />R 'OJECT ADDRESS <br />5113 S 4th Pve <br />orm+eP Maitwoness cm nr r��or+e <br />Britt 5 Kathryn Thompson 1023 Hoyt Ave Everett 98201 252-3976 <br />�F.NpNT MAILAfIOPF.55 dTV ]iP PHONE <br />�RCHITCGTORpE51GNEp MRII��DR[55 CItY ]ir PNOM1E <br />i�P PIION[ $IRiF IICC45E • <br />MhLNANICFLCONiR�CiOR MAILRDDPE55 CIiY 71P PIIONE STAiEUC[NSE� <br />PWMBINGCONLPnf,IOR M41lApDPF.55 CIfY ZIP P110NE STAT[IILENSE� <br />CONiRACT FHICE OF WORN <br />DESCRIBE WORK P4D SOUARE FOOT�GE INVOLVED <br />wall 6 parki <br />�/-� � 3 - <br />LEc�L oESCnIrTION oP PtiOPERTV ISHOWN BElow IXi <br />l0T PIOCN Of_ <br />PARCELT�%ID.NUM9EN <br />1150U3-016-007-0005 <br />CONSTRUCT�ONIO�NLENDER.RDpRfSS.TELEPHONE NUMP[q <br />�r����ay <br />LAVATORV (WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />SINK (SERVICE — BAi <br />[a: <br />HEATING SYSTEM: I i GAS f� ELECTRIC f"1 <br />CONTACT PER50�� �ND PIION[ ND <br />area Kathy 8941 <br />� I HEREBY 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 ORDINAFICES GOVERNING THIS TVPE OF <br />WOPK WILL BE CUtAPLIED WITH WHETI.�R SPECIFIED HEREIN OR <br />rnocoaiesi NpT. TH[ GRANTING OF A PERNAT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIQLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATF OA LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERiY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />� SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: �� �3 <br />fRONIS[TPACR REMSFipACN SIDE <br />I1S[ ION[ <br />IIEIGIIT UMILATION <br />NO 0� SIPaIE$ <br />X <br />SI:NAIURE DA1[ <br />CITY AUSINf.55 UC[NSC NO <br />NO. TYPE OF <br />rva.—rvnrvvw unna—n.r. <br />FORCED AIR SVSTEMS — B.T.U. M <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHESDRYERS <br />VEN7ILATION FAN <br />WATER HFATER <br />WOODSTOVE <br />MEiq� FIREPLACE � <br />FIREPLACE INSERT <br />GAS FIqEPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTF�N <br />SUBTOTAL $ <br />PEfiMIT 5 <br />TOTAL FEE $ <br />PIGNCIIECK.tyUM13CR � fCP � REf.fIPiNO. <br />101 �q[A VnCRNI SIIF httS_ <br />IIYEE I1 NO BIIIIOMC <br />NO Of DWELLING SIIE Of BILG/LI <br />❑Mf5 p�pMpiNO <br />OCCUt`ANtIORU PRSEMENi MECM�N�CAL <br />I l YE5 � � NO <br />f1FR50Y Pp011104A1 PL�N CIIf.GN <br />Oil�[R <br />Rf�cpN <br />$LI.iE OUiIDMG SURCH�RGE <br />rinNsn�rnoveoer CITYOFEVERETT rnnur.wonrcs <br />C�j7'L LOCAL SALES <br />��q�E O TAX CODE IS 3105 TO7nL <br />