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APPLICATIL�J FOR CANSTRUCI _JN PERMIT <br />CITY OF EVERE1l' • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDINC Ca" MECHANICAL ❑ PLUMHING ❑ SIGN <br />PROJECT ADDRESS:_ :2'l l\, V� !•� ,n� n A..z <br />Liaile., Mn„ N:I.�.] W�1...;,,��a�. L✓e-�t� 96':�u_:i 2i9 -�4tiS <br />OWHER MNI�OdiE55 �ITV SiP PNONE <br />7ENANT MMIADpRC55 �iTY <br />AlIC111tECT OR <br />GENER�L GONiMLTOn <br />M�II <br />MML ADDRE55 <br />]iA <br />7�r <br />PNONE <br />I ICENSE � <br />NECN�NIC0.CONTRACTOR M�ILAIX%iE55 (:ITY ZIP i'110NE ST�tEUCENSE� <br />r <br />Lv1f.,rern S�•��'� Sl�.a�'inr'�',l J.��x �svx Lrht'�'4 qfr.7ol• 2S,i•3na E✓C�C'GS•S�;LIkT <br />PLU INGCONiR1C10{I M�IlA0ptE55 CIiV 11P i'110NE STAIEUGENSE� <br />CONiMCT PPoCE OF WORM <br />� .� � . . <br />SOl1�NE FOOtK.E tn'VOlVEO <br />LEGAL OESGRIPTION OF PROPEPtt IS�IOWN <br />l0T BIOCN <br />PMCEL TAX ID. NUMBER <br />GONSTRlICT10N IONI IENDEH, AOD11E55, IElEP110NE NUMBER <br />WATER CLOSET <br />BATHTUB <br />KITCHEN SINK 3 DISP <br />DISHWASHER <br />UUNDRV TRAV <br />CLOTHES WASHER <br />URINAL <br />SUB <br />S <br />FOR OFFICE USE ONLY: <br />iRp1T5ETB�CK PE�f15FTBACR SIDESETBSCN <br />USE ZONE <br />HE�GHT LIMIT�TION <br />OLCUPANGY NO (1[ 5 <br />GRWP <br />FIRE SPRINNIE(1 REO'D <br />FIRE MAIiM REO'D <br />LOf MEA <br />HO OF UWEL4NG <br />UNi15 <br />V�C�NT SIIE <br />❑YES ❑ NO <br />SIpE OF BIDGrtI <br />❑1'ES ❑ N7 <br />HEATING SYSTEM: ❑ GAS ❑ EIECTRIC O <br />CONT�CT �F.PSON M!D V,f10NE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br />APPLICATIOtJ AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. TfiE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW FtGI�LATING CONSTRUCTION OR THE <br />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF 7H15 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br />x_ Y�t l.{t-ti.�^'t � �.�i •� o' 7� <br />SIfiN E D�TE <br />CIiY BUSINESS IICCNS[ NO <br />N0.1_ 7YPE OF EOUIPMENT � FEE <br />I A/C—AMNDLGUNfTS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />DRYERS <br />HFATER <br />METAL FIREFLACE <br />FIREPLACEINSERI <br />GAS FIREPIACE <br />GASRANGE <br />GAS PIPING <br />EXHAUS7fAN <br />PI�N qIFCN NU11pFR <br />� ? � . <br />OIIiIDINC <br />PIUAIOMG <br />MECII�NIC�I <br />�pD1IlON�1 �I�N�HfGN <br />ou�en <br />RFA$(p! <br />51A1[ OU�l�M6511BCPA0GE <br />rinHsenrnovenor CITY OF EVERETT ruxnr.wonKs <br />LOCAI.SALES —� — <br />n„iE TAX CODE IS 3105 TOTAL <br />PERMIT S <br />TOTALFEE f <br />r¢F InccemrHo <br />