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tl <br />-� <br />APPLICATiO.� F6R COII�OSTRUCTIJN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION �J <br />320G CEDAR STREET • EVEREIT, WA 98201 • 259•8810 l <br />❑ DEAAOLITION ❑ COMBINATION ❑ BUIIDING '� MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: � 5�`�� �� j p ���po � j� p <br />•RLMTECTORf�SIGNER M�i1�DDqE55 arr m r��or+e <br />GENEMlCpIiMLiOq M�III�WRE55 CiIY r�� <br />. ���ONE $GTELICENSE• <br />ior <br />� <br />COMSTIM�CTON LOIW tENOER. �Od1E55. tEIEPlIONE NUMgER <br />�V�� <br />NO. TYPE OF flXTURE OR ITEM �E <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />UUNDRY TRAY <br />C�OTHES WASHER <br />URINAL <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USF l)NI.Y: <br />�ROM75ETBACK PEAqSFiB�CK SIpE5ET8�Ck <br />USEIONE lUiM1E� V�C�NISIfE <br />❑Y6 O NO <br />HEIGMT UMITRION NO Oi OWELIING SIZE O: BtOGRI <br />UNIIG <br />� <br />OA1� <br />er <br />❑YES ❑ NO <br />IiEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />CONT�Lf PfN50N AND PNONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINFD 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 8E COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION Of ANY <br />OTHER STATE OR LOCAL LAW REGUUTINf3 CONSTRUCTION flp THE <br />PERFORMANCE OF CONSTRUCiION, THAT 1 AM AUTHOfiIZEU BV TME <br />OWNER OF TMIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH TNE SiATE <br />CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br />5A'�� um "..� ��!£i,l�l� <br />���QC D�TE ' <br />CITV BUSINE55 LICENSE NO <br />EQUIPMENT <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD £'OVE <br />PI1�CE (WOOD <br />INSERT (WOOD <br />GAS PIPING <br />i`l �N CI I[Ck NUMflf R <br />OIIIIpMG <br />ri.ur.miur. <br />MfCN�Nif.N <br />�DpI11pNM �ILNCIIf.CIt <br />o�;�n <br />sini¢ nunoiNr, s�mr.nunr,c <br />CITY OF EVERETT � runur, wonrs <br />LOCAL SALES <br />TAX CODE IS 3105 , TOTAL <br />SUB TO <br />PERMIT <br />fff � RFCEIPT NO <br />—T <br />