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APPLICATIQt� FOR CONSTRUCTII .�l PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8870 <br />❑ DEMOLITION ❑ COMBINATION fl BUILDING �] MECHANICAL ❑ PLUMBING f-I SIGN <br />PROJECT ADDRESS <br />/�07 �/,�,��/ti���- 1��%- �"vd�'c-r--r ��'s�'c� <br />OYMER/��^,/ MNLi/1OyD�RESS Gltt� �� � ZIP PNONE <br />KI(� C�[�`��''\'��� �%C% I//�<C7�i�/� ��C GI/'���'9T �fiifi� %>�S�'`. <br />TEIUNT MNLADIXiE55 CITV 21P PNONE <br />MCMITECTOIiDE51GNEN M/JLMDRE55 CITY 21P PMONE <br />OENEflKCONTM:TOR MAIL/�ODAESS Cltt 21P pNpNE $7AlEUCENiE• <br />PLUMBINGCONTPACTOR MNL�ODRE55 <br />CONTMCT PRIGE OF N9HK O p <br />� � ^ �� <br />DESCRIBE NVfiK AND SOUME f00T�GE WVOIVEU <br />ti�j��L �J,nOo .f�?c�t <br />N�-�-. ��s � f Uk'.�/.4� <br />P�Q}ISfi OF BINLDINO <br />�% \ <br />IEML DESCRIPTION OF P110PERtt (��� �IOW OR �TTACM 7W0 <br />lOT BLOCI( OF <br />PARCELTA%I.D.NUMBEH <br />CONSTflUCT10N LONI LENOER, I1001iE55. iELEPHONE NUMBER <br />PLUMBIN6 <br />NO. TYPE OF Fl%TURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATMTUB <br />UVATORV (WASH BAS�N) <br />SHOWEfl <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TRAY <br />SUBTOTAL S <br />FOR OFFICE USE ONLY: <br />FilOHT6ETBACK REM7 <br />USE20NE <br />❑YES ❑ NO <br />HEI6HTl1MITATION NO.OFDWEWNO SIZEOFBIDG/f.l. <br />UNITS <br />❑�ES ❑ NJ <br />ZIP PIqNE STATE <br />HEATING SYSTEM: �1 GAS ❑ ELECTRIC fl _ <br />LONTACT PERSON NID PHONE N0. <br />�.�%�.¢/11 %�'�- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETNEii SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION Of ANV <br />OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR TME <br />PEHFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICM <br />APPLICATION IS MADE AND I COMPLY WITM THE STATE <br />CANTRACTORS LA/W1 1827 RCW AND 286200 WAC. <br />�//" 1'"- � � � " � <br />, . � C. �/%/9S <br />SIGNA�URE DATE <br />CITY BUSINESS LILENSE NO. <br />� NIl1Yl/L�] V IYI I J� I <br />iccn nio cvsrcuc — <br />UNIT FiEATERS — B.T.U. M <br />ISIakP <br />FIREPLACE <br />GAS PIPING <br />EXHAUST FAN <br />TOTAL E <br />- I FEE I PECEIPT <br />OUIIDINC <br />PLUMO�N� <br />MECMNIICAL <br />AL �.IPIANCMECK <br />_ii <br />PEASON <br />, .1�TE BUIIDiNG SURLH�RGE <br />PUNSAPRiOVED BY CITY OF EVERETI I PUBLIC WORKS <br />LOCALSALES i <br />oae TAX COUE IS 3105 I TOTAL <br />