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.1. <br />APPLICATION FOR CONSTRUCT��ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 982U1 • 259-8810 <br />I l DEMOLITION f 1 COMBINATION �BUILDING I-1 MECHANICAL � l PLUN,8ING f l SIGN <br />PROJECT ADDRESS �7 / � • . � � <br />�/ Z f�' (.(/er f / ec✓ � v'r vf �ve� � <br />OWNER MRI�A�,p9^ E55 CI ZIP PHON[ <br />J��� �wce I� zSZ� G'��, �t , ��e�r� G/y9 7��r �.�f' 9�33 <br />TLNRNT IA/.ILRDDRESS f.liY ].iP PIIONE <br />���� 1,cw�n�coionn�[� man roNe55 CIiY /� ]IP �] PHONf �% <br />.UG,.4.tC I7awt �C'SrciM !"'el I7lS— /%'GGcr �✓QIYN 3S�`OS`3� <br />GFNERAL TMCiqi rAA1LADDPL55 `� Ci1V .iP PHONC <tATf:liCENSEr <br />u�n.�J <br />NECHAN�C/•L CONTRACTOR MM� ADDRF.SS CITY IIP PIIONE STAiE I ICGNSE � <br />PLUAIBINGCONiRpf,iqi MAIIADDRE55 CITY I�P pHONE STAiEUCENSE� <br />CONiq�CT PRIC[ Of WORN <br />HEATING SYSTEM: I i GAS f l ELECTRIC f l <br />DESCPIBEWORK�Np50URREFOOTqGEINVOLV D CONUCTPEPSONANDPHONENO <br />_ �P „o f w` o,i�. o <br />�roo Co v e,,-i 2 7ZS' ,t�. ^ <br />-�{,p/� Of {�/�/(c{'Iscv��+cll GrQ�.^/- I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />LOI Y -� _ ALOCK <br />lOW OR ATTACH TY.'0 OPIES) <br />or 1��'.P v-� � rf � <br />i�,� a <br />rGOsX D o0 os� oo.ti= <br />CONSTRI/CTON IO�N IENpER. RDDRE55. TELEPIIONE �NMpFR <br />PLUMBIfdG <br />NO. <br />8 <br />SINK <br />OR ITEM <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />fRONi5F1PALK p�Ap SFTPRCN <br />USB ZON[ I OT RttE� <br />11[IGIR UMIL�iION NO OF OWELLING <br />�,NiT� <br />OccurnNcr N000s�onits oc:cunnNtto>o <br />r,nour <br />Q-3/v•� ! , ivi, <br />rinc <br />�— � �4TE <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNINCa THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WFIETHER SPECIF�ED HEREIN OR <br />NOT. THE GRANTING OF A PFRMiT DOES NOT PRESUME TO G!VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CON5T7UCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOIa WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CON RACTO S LAW � AND 296.200 WAC. <br />X �� -�� - %� <br />LIC[NSE IJO. <br />FEE O. TYPE OF EOU(PMENT <br />T <br />� NC—AMN�LGUNITS—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. <br />i HEAT PUMP <br />—� <br />UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />VENTII ATION FAN <br />� RANGEHOOD <br />T <br />� WATER HEATER <br />WOODSTOVE <br />META' FIREPLACE (WOOD BURI <br />FIREPLAC[INSERT(WOOD BUR <br />i GAS FIREPLACE <br />� GASRANGE <br />SIDE SE�BRCR <br />VACANt SIiF <br />IiVES II NO <br />PL4N <br />eunniva <br />SIZE OF BIOGR I <br />IS'7, riuumu: <br />BRSEMENI M[CIIRNICPI <br />IIVES 1� NO - <br />�DDIIIONPL 1'LpN CHF.CK <br />OIHCR <br />STAIE OUIIDWC SURQUqf,E <br />CITY CF EVERETT ruAuc worKs <br />LOCAL SALES <br />TAX CODE IS 3105 TOiAL <br />SUBTOTAL $ � <br />PERMIT 8 � <br />TOTAL FEE S <br />fEF R[CfIPTNO <br />VALUATION FEE <br />T <br />3�—f <br />�'� - a� ;�o <br />