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,- �. <br />APPLICATIL N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EV�ERETT, WA 98201 • 259-8810 ���» <br />❑ DEMOUTION ❑ COMBINATION ❑�/ BUILDIN(i � MECHANICAL ❑ PLUMBING ❑ SIGN <br />PRO.IECT ADDRESSz U�l� o Z l.F,•¢7'h1dR � <br />1' �li �e w <br />n <br />���.,_ �5'4oZ a�`����a�'� Ed�w��t Q�s'oz3 ?oG �90 69�v�/ <br />TErur+T uui.00ness atv zin r�or�e <br />ARC111RCT pi OESIGHER uu� �ooaE55 cin �m rHpnE <br />�, <br />�oT <br />._.. I _ . _..___ <br />%7 S 7lLn.C. J U k �' O <br />4ML <br />(�O <br />� vnorenn �s��q+n+ ee�ow aa �n�eN <br />e�ouc oF <br />'�/9s8-aoZ -6,3 - opos <br />PMCFL TAk 1 D. Mll.lER <br />CONSTRIICTION ION/ IENDEN. Md1E55. TEIEPIqHE MMSER <br />��� <br />UVATORV <br />FOUNTAIN <br />PREVENTERS <br />CE — BAH, ET <br />SUB <br />CIfY <br />�a..��,���. <br />nTM <br />FOR OFFICE USE ONLV: <br />fRd1T5ETB�Ck REA115FTB�CN $IDESETB�CN <br />USE 2d+E <br />HEIGNT LIMIT�TION <br />� <br />FEE <br />I��' l PNONE SMiE <br />bItCJ. Qaii�tifc... 1�fls.� 3Fo6 <br />]IP 1 P110NE 5�T E U NSE � <br />� � G"Q�%�i��2.:P /� Z <br />ZIP PNONE ST�TE LILENSE r <br />HEATING SVSTEM: �GAS ❑ ELECTRIC O <br />CONTACT PER$pry AND PIpNE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTIN6 CONSTRUCTION Ofi THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTF10iiIZEL 8V THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK fOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CANTRACTORS LAW 1827 RCW ANO 296200 WAC. <br />Y/yfY _� .c.�_.>� � '' O — 9 % <br />•� DATE <br />CIiY BV9NE55 LICENS[ NO <br />Q <br />NU�NIl1�ULl� VIYIIJ <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATEPS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />MEiAL FIREPIACE (WO( <br />FIREPLACEINSERT(WO <br />GAS FIREPLACE <br />GASHANGE <br />SUBTOTAL f <br />PERMIT S <br />TOTALFEE E <br />PUNCIIECKNUMpff1 � f[F � AFCE�Pf NO <br />lOT �PEA VI�C�NT SITE FEES <br />❑YES ❑ � yU1l01NR <br />NO OF DWELL�NG SRE OF BLOG/f I <br />UNiiS PUIMOMG <br />OCCUPAM LO�D BASEMENT MfCH�NILM <br />❑VES ❑ NO <br />�f�� eDDI110Ne1 PUN G11CCx <br />U1HER <br />RE�GON <br />Si�l[ BUIIDMG 511f1C11�It0E <br />rinNs�rrnoveoar CITYOFEVERETT ruaur.wonKs <br />LOCAL SAIES <br />o.,E TAX CODE IS 3105 To7Al <br />