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APPLICATIC .�1 FOR CONSTRUCT �ON PERMIT <br />CITY OF EVERETT • BUILDING DlVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COK"NATION f1�1 BUILDING fl MECHANICAL r� pLUMBING fl SIGN <br />FHOJECT ADDRESS - <br />�,S'U 'Z ,I�.4vir�?� G�/,�t� <br />OWNER M111LApDRE55 CIiV ZIP PNONE <br />,t�i2t?1-�J llfcc7ur-�ic- 95oz ,��v,a�r� u��u �v��i.c�r-r 9�ao� <br />1ENAN M�IL��DRESS Cltt� ZIP PHONE <br />�RCHITECTORUESIGNER MNI.A�DRE55 �Itt �ip m�nuv <br />�inuvrmoa �dob l�}j /1[�}jl��fJ/j� ZIP PiIONE $i�TEIICFNSE• <br />��yso�l-LtJtr'STL�x.v .u.f E?J�ic�- qsan3 347�imz {,/9tilsnu�coSaL� <br />MEGHRNICRLCONTqqCTOR M�ILAOW1E55 f.ITV 21F PIIONE STRTEIICENSE• <br />PLUMBING CONiR11f,TIXi M�IL ADDRE55 CIIV 21P PNONE STATE LIGENSE � <br />CONTR�GT PRICE OF NqRK <br />_/a�S� <br />OESCRIBE WORK �ND WUARE FOpTAGE INVOLVED <br />/1 <br />_ . _ _ . � _ _ i. / <br />l0T �/� BLOCK OF u c� <br />i�taiS�o J d Z <br />PARCEL T/Uf 10. NUMBER <br />39�(i,� ' - c�oo <br />CONSTRUCiIONIO�NIENDER.�DDRESS.TEIEGHONENUMBER <br />' PLUMBINa lllo �U <br />� NO. TYPE OF <br />� WATER CLOSET� <br />BATHTUB <br />Yi:L\1 <br />FOUNTAIN <br />AIN <br />JPREVENTERS <br />JICE — BAR. ET <br />PERMIT <br />FOR OFFICE USE ONLY: <br />fRONTSETPJRCN �� , REPRSF.iBRCK <br />(/!/ ' J� <br />USE ZONE rl IOT pREA <br />/C.� � � <br />IIEIGHTUMI�Oi � NO(xDWELLING <br />11NitC <br />FIRF. 5�'AINKIER REOp <br />� <br />E <br />HEATING SYSTEM: fl GAS fl ELECTRIC f l <br />F6RTA§T FERSQN �ND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOIY i i1E SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WH'cTHCP SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES PlOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL i NE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON � FiACTORS LAW 18.27 RCW AND 296200 WAC. <br />�a.� �a�v�.d.e».J 9- a s- 9 �� <br />SIGN�RIRE D�iE <br />dTY BVSINE55 LICEN£[ N0. <br />FEE NO. 7YPE OF EQUIPMENT <br />' A/C—A/FiYDLOUNIiS—H.P. <br />; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br />� HEAT PUMP <br />; UNIT HEATERS — B.T.U. M <br />, SIDE SETBnCN / <br />VACRNI $IiE <br />f1YES I1 NO <br />GAS FIREPLACE <br />GASRANGE <br />GAS P�PING <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />Pl�NC11ECKNVMOfR FFP RECEIPtNO. <br />!��\/,�� �Q'% /� <br />OUiOWfi <br />SIZE OF BLOG/f I <br />�7�� .$F q/(A � "'wun��vc <br />BRSEMEN�T M[CIIPN�CAL <br />i4iES Il NO <br />ApU1110N4L t'I AN GHf.CK <br />onien <br />STNE FIUilDM6 SURC114q6E <br />qTV OF EVERETT runnc wonHc <br />LOCAL SALES -- <br />TAX CODE IS 3105 TOTAL <br />