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APPLICATION fOR CONSTRUCTI�..� PERMIT �,�}�. <br />CITY OF EVERETT • BUILDING DIVISION �/'�%� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 ���' <br />❑ DEMOUTION ❑ COMBINATION f7 BUILDING MECHANICAL f] PLUMBING rl SIGN <br />PROJECTADDRESS /5G/� G,,�A�NG(T <br />s� <br />OYMER M�IL�DORESS CITY IIP PHONE <br />� Wi'T.�iNs /SGG� GJA��v�t/ E���'i?T �ZO/ �� �j - 9�1I <br />TEtUNT MAILA70NESS CIiY 21P ONONF <br />APCMITECTq10E51GNER MIUL/iU0{IESS GITY IIP GMOHE <br />6ENEMLCONTMCTOq MNLAOORE55 CITY ZIP PHONE STATE4CEN$E� <br />NEqIMMCILLCONTMCTOR M/JLADDRE55 CI <br />�s� <br />nu,.exx� corirrucron Mut woRess a <br />���G170� <br />DE9CRME WdM( MIO SOUARE FOOTAOE INVOLVED <br />�n��rc� NkTv2h�.l=,/as r-��,.,kc�(- <br />P� Pi a �4 -r� -Fu �ac� �- r,�n-�z <br />t�Fa� <br />rnovoseo use ac su�ara � T(\ <br />IEOILL OESCiWiIOM OF PROPEIIiY ISIIWRIlELOW OR �TTACN MCl COPIES) <br />LOT lIOCK OF <br />PNqCELTA%I.D.NUTABER <br />CONS7iN1C110N LOMI lENOER. �Dd1E55. 7ELEPIIONE NUMBER <br />��Meu�ii <br />NO. TYPE OF FlXPJRE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVA V (WASH BASIN) <br />SHOWER <br />KITCMEN SINK 8 DISP <br />FOR OFFICE USE ONLY: <br />FNONT 6ETBACK REM SETBAGK <br />USE 20NE <br />�ioNT uMrt�na+ <br />nPe <br />SUB TOTAL E <br />PERMIT E <br />TOTALPEE S <br />�iT� ov�wna <br />D�TE <br />SIDE SETB/�CIc <br />HEATING SYSTEM: <br />CANTACi PERSON M!D PHONE <br />rrnme <br />.�.u.� <br />I <br />GAS ❑ELECTRIC fl_ <br />�����-�fi� zs��-�� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TMIS <br />APPLICA710N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIviJS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CAMPLIED WITH WMETHER SPECIFIED HEREIN OR <br />NOT. THE �RANTIN6 Of A PERMIT DOES NOT PFESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY <br />OTHER STATE OR LOCAL lAW REGUUTINO CONSTRUCTIQN OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORRED BY THE <br />OWNER OF TMIS PROPERTY TO PERFORM THE WOfiK FOR WHICM <br />APPLICATION IS MADE AND I COMPLV WITM TME STATE <br />CONTMCTORS LAW 1827 RCW ANU 2BBZ00 WAC. <br />� 7„ i/ �,�-- //Z�/ 9s <br />NO. <br />Q <br />RANGE <br />❑YES ❑ � BUIlDIN4 <br />S12E OF BIOCLf I. <br />PLUMBINO <br />B�SEMEN� MECNrWICAL <br />❑YES ❑ NO <br />AOOITONAL PIAN CNELK <br />OTHER <br />STATE BUILDING SVPCH�RGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />IRE OR ITEM <br />- H.P. <br />- B,LU. M <br />- B.T.U. M <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />• <br />