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APPLICATIO�I FOR �CONSTRUCT��UN PERMIT <br />CITY OF EVERETT • DUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />n DEMOLITION Kl COMBINATION n BUILDING n MECHANICAL r 1 PLUMBING fl SIGN <br />PROJECT ADDRESS <br />�� <br />` ��^ i� <br />ARCHITEGTGROES�GNER M�IInODRE55 <br />cm <br />f.ITY <br />GIiV <br />r�+or+r <br />Z <br />%UMBINGCONiRAf,TOR M�IL�DDRE55 CIIY ZIP PhONE STRiFLICENSE� <br />CONTR�CT PRICE OF WORK . / <br />��/ <br />DESCRIBE WORR �NO SOUnRE FOOT�GE INVOLVED <br />�or e�ocu . <br />_ /l� 7� � <br />V ��� —��' <br />PMCEI TAX 10. NUMBER <br />ADpRE55,:ElEPHONE NUMBEP <br />TYPE OF FlI(TURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />UVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRY <br />CLOTHES <br />URINAL <br />SINK <br />SUBTOTAL $ <br />PERMIT 9 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fRONTSFTPRCK RE�P SFTB�CN <br />7�%� / �/.� / <br />USEZONE/, IOTAREA <br />/�- ' � <br />IIEIGIITLIMIT�TI j/� � NOOFOWEIIING <br />7t�, uNitc <br />iYPF Of f,ON9 <br />�-/�i <br />i)Ri6 <br />FEE <br />0 <br />HEkTING SYSTEM: I� GAS tjC ELECTRIC f l <br />LONTACT PERSON RND PHONF NO <br />I HEREBV CERTIFV 1 HAl' I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW � HE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR <br />NOT. THE CaRANTING OF A PERMIT DOFS NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM 1HE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />%�� ��— z�neTPS' <br />SIGN�TURE ppTE <br />diY BlI51NE55 LICENSE N0. <br />NO. � 7YPE OF EOUIPMENT I FEE <br />— rvrnvuw urvi � a— n.r. <br />CED AIR SYSTEMS �— B.T.U. M E.A. <br />SIpESETBRf.Yy� Pl�Npl[CiNUM�E� <br />S � Z <br />vncnr�t SirE FEES <br />f � VE5 f I N0 ppll DMG C`� <br />SIZE OG yLD(:rt l / ' <br />57� SSf- C •v�`f rwumrvc <br />B�SEMENi � M[CMAMUI <br />i1PE5 Nf0 <br />Af]pI110N�L PI.hN CNf CK <br />OINER <br />SiAi[ OII�I�iNG SIIRCHnRGE <br />CITYOFEVERETT rum�r,wonKs <br />LOCALSALES <br />, TAX CODE IS 3105 7oiAL <br />— B.T.U. M <br />yc1J <br />FEE S I � <br />rce necrm�No <br />�/�i/ /7 <br />� <br />'. 1 <br />i <br />