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APPLICATIC� l FOR CONSTRUCT. �N PERMIT <br />CITY OF EVERETT • BUILDING OIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION B' BUILDINQ ❑ MECHANICAL ❑ PLUMBING ❑ SION <br />PROJECT ADDRESS: S(� ( Cj ,�,,,�„ � �,�o._. <br />4�RMIXIE55 <br />ZIP <br />TENN/T 4N1�D011E55 GTY IIP p�pNE <br />� 1� <br />NiLMTECTOR0E51GNER MIUl11DIX1ES5 CITY Im pHpryE <br />ri i.iY\Q i� �\ ✓✓�� <br />GENE(UICANiRJ1CTpi 4All�WRE55 CIIY jiP PIqNE SIATEUCENSEI <br />MECNIUMCALI:ONTR�CTqI YMI�ODRE55 fA1V ZiP PIIONE ST�TELICENSE� <br />PLUMBINiCONTR11C10R YIJlA0IX1E55 CIfY 11P PIqNE STAtEIILFNSE� <br />FOpTMiE <br />R10PEPTY <br />ior <br />Ld1N LENOER. Nl[M1E55. TELEPIIdlE MINlER <br />v�urenxs <br />�— <br />BATNTUB <br />IAVATURY <br />DRINKINQ FOUNTAIN <br />ROOR DRAIN <br />BACKFl.OW PREVENTERS <br />SINK ISERVICE — BAR_ FT <br />FEE <br />SUB TOTAL f ; <br />PERMIT ; , <br />I TOTAI FEE f ! <br />FOH OFFICE USE ONLY: <br />FIIONT SET9ACR 11EM SET&�CN SIDE SETB�CK <br />zs- � zs-' 7, s ' <br />USEZONE_ r� IOT�REA VACNITSITE <br />/� OYES ❑ NO <br />a <br />J <br />no. ac owewra <br />� UNIfS <br />s�tE or a�oarr i <br />❑YES NO <br />HEATING SYSTEM: <br />CONT/�CT PERSON �NO p110NE <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PRONSIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPIIED WITH WHETHEF SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OP ANY <br />OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AU7HORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOq WHICH <br />APPLICAT!ON IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br />7� � � y/k � <br />5 �T � 11TE <br />pTY BUSINESS IICENSE N0. <br />MECHANICAL <br />NO. 7YPE OF EOUIPMENT FEE <br />FORCED AIR SVSTEMS <br />HEAT PUMP <br />INSERT <br />GAS PIPING <br />IXHAUST FAN <br />PlANC11ECANUMBEII !EF /1 NECEIPT <br />.-� �h:�� ///�. <br />flWLDINf. <br />FIUNBING <br />MECNeNtC�l <br />�UOI IION�L PL�N C�IFGIt <br />O11�ER <br />S1�IE BUILOINC SIIfICH�O6F <br />�..�.�. �.unm v�11ry5N'YHayeo er CITY OF EVERETT PIIBIIf. WORKS <br />��W LOCAL SALES <br />�—u o�re S/d/9(o TAX CODE IS 3105 TOTAL <br />