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APPLICATIO . FOR CONSTRUCTI.�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �C���� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION p BUILDING � MECHANICAL ❑ PLUMBING <br />PROJECT ADDRESS: � R'p � /,)e�„. . u, ;Q, . _ .� . � , ❑ SIGN <br />-o9i/ <br />,.�. riP r�wne <br />•RCMTECTpR0E51GNER MMLApORE55 ��n. -------� <br />���� P110NE <br />6ENER�ICONTR11�i0q M�ILAOORESS ���� -- -- <br />/ ���� ���ON[ $lREIICENS[� <br />�G�fruc/tar7`' �a�-� i9o4 3,..! Av� .�oa�5// 9rQ/d/ /082 -3030 <br />MECNMIIClLLCOHTR��TOR AILADDRE55 <br />cirv .. <br />n� <br />�oi <br />' / /7cI-40CI� <br />�� �MMLAppRE55 <br />WOPI( <br />SOUAREFOpTAGEINVOIVED <br />PIIONE <br />u�ervst � <br />lIV � P110NE L�/ <br />i'LOG� %.PG'4GO1J STAfEULENSE� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CpNUCTPCf150H�ND IIONENO <br />�.� n n �ed� /on/. 1 7F.f.,e%w n <br />1 HEREDY CERTIFY THAT I HAVE READ AND E%AMINE� THIS <br />�owo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORR[CT qLL <br />PROVISIONS Of LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�P�PERn'15MOWNBELOwOqATTALHTWp�OVIES� WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT�NG OF A PERMIT DOEE NOT PRESUME TO GIVE <br />e�°�K oF AUTFIORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAI. LAW REGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR2ED BV THE <br />OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />a CON7RACTORS LAW 10.27 RCW AND 296.200 WAC, <br />CONSTRUCTh7N LOAN LENDEq,AppqE55. TEIEPNONE NUMBER <br />TVPE <br />WATER CLOS <br />DISP <br />FEE <br />LITV BOSIHESS IICENSE NO. <br />NO. 7YPE OF EOUIPMENT FEE <br />A/C — AMN�LO UNITS <br />_ FORCED AIR SYSTEMS <br />HEAT PUMP <br />GAS <br />SUB TOTAL S � <br />PERMIT f <br />rnrei FFF < ' <br />FOR OFFICE USE ONLY: <br />FRONTSETB�GK RE�RSETB/.rK SIOESETBACB pinNCllC>Nl��q_/ <br />l <br />USEZONE �l <br />iotea¢n veceNrsrtc FEES <br />__ ❑YES ❑ NO <br />OUIl01NG <br />MEICNT UMIiAf10N NO OF �WELUNG SIZE OF BlOG?I <br />UNI�C <br />ra a <br />PLUGOINC <br />i�SEMENI MEC11nNILeI <br />❑YES ❑ NO - <br />�ODqIONAI PI�NCIIfCK <br />0111Ep <br />Sint E nlln DMG 5Un . 1 <br />CITYOFEVEflETT �uniir.wonns <br />LOCAL SALES - <br />TAX CODE IS 9105 ToiAL <br />SUBTOTAL <br />PERMIT <br />FEE � � I REf�� � /��S <br />a <br />