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APPLICATI�"A1 FOR CONSTRUCT" 7N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDINCa ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�} P�R,t/OJpECT ADDRESS: -�, 'j 7 � .?/ <br />v �.��b_1_n�ro ., . //n � n/1 / �%Pn� �./�/,J 9 � �� � z�(o �J J .S � � Z1 <br />OW'1ER MMLA�55 f.l IiP 5 PNONE <br />TENNIT Mq�App{1E55 CIIY 71P PUONE <br />�11CItlT[�TORDEpGNER MMIGDDPE55 ��ry ��p pH�E <br />GENEf1Alf.pNTMGTdi M�IlAW11E55 CiiY )�P PuONE $I�TELICENSE• <br />MECNMlICKCONTR�CTOR M/uLADDRE55 f.IfY 71P PIIONE S1ATElICENSE� <br />PLUMB�NGCDNTRII�TOR MMLADDqE55 f.11Y Z�� PHONE $iATEUCEN$E� <br />[FSLWlE WJNK <br />icuw� vea�.nir� i�n u rNu2n� � ISnqwn �.Ow Oq IIRAGH TWJ CO%ESl <br />��T BLOCK OF <br />PMCEL TAII I.D. NUMBER <br />CdISTRIILTON ION/ LENDER,AODRESS. TEtEP110dE MJMBEN <br />_�_" "_"_�_�_'___. <br />PLUYBIN6 --. _.. _. .---�-'- <br />NO. TYPE OF FlIfTURE OR ITEIA FEE <br />WATER CLOSET (TOILE� <br />BATHTUB <br />UVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN S"''�. JISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DHAIN <br />� SUB TOTAL S _ <br />PERMIT S <br />TOTAL FEE f- <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CN REAq SETBACIt SIDESEiB�GK <br />USEIONE LOT�RF� WC�NiSIiF. <br />❑YES ❑ NO <br />NE1611T UAIIT�iION NO OF UWELLING SILE Of BIUGR I <br />UNiI$ <br />rm:t�i <br />UAiE <br />❑YES r+0 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />❑ONT�Ci PF.RSOH ANO PNp1E ND <br />I HEREOY CERTIFY THAT I HAVE REAO ANO E%AMINED THIS <br />APPIICATION AND NNOW THE SAME TO BE TPUE ANO CORREC7 ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OH <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br />x / ,� "fS-96 <br />SIGN NE D�IE <br />Cltt BUSINE55 LICENSC NO <br />MECHANICAI <br />NO. 7YPE OF EOUIPMENT FEE <br />N V — Nl11Vl <br />FORCED AIR <br />HEAT PUMP <br />ES DRVEHS <br />HOOD <br />HEATER <br />FIREPIACE INSEFT <br />GAS FIREPLACE <br />GASRANGE <br />�AS PIPING <br />EXHAUSTFAN <br />PERMIT S <br />TOTALFEE f <br />PI�NCIICCKNUMqft1 fEF I1Ef.FIPTNO <br />OIIIIDWG <br />PIUMpING <br />MFf.1lnNif.M <br />�DpIIION�I. 1`UN C��fCN <br />on�en <br />Si�IE OUIl�IN6 SIIDCII�pfE <br />CITY OF EVERETT rimur, wonn5 <br />LOCAL SALES <br />TAX CODE IS 9105 70TAL <br />