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APPLICATIG� FOR CONSTRUCT:�N PERMIT <br />CITY OF EVERETT • BUILDING DIV'ISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 ����t <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDIN(i ❑ MECMANIC L � PLUTABIN(i ❑ SNiN <br />PROJECT ADDpESS: �� OS S�jK�j� QQ �� <br />�RCINTEGTORLESIGNER M/Ul�D0iiE55 GITY )iP PMpNE <br />C.ElIEiW CONTMGTpi MNLAOORE55 GiY iIP pupyE Sf�TE IICENSE � <br />MEdUMC�lCON7MCTOR M�IIADDi1E55 f.ltt zlP P�E ST�7E110EN5Er <br />VIUAMRlGCpITP/iCTOR MA11110DRE55 CIIY TIP PNONE CTpELKFNSE� <br />�I <br />F00TI10E NVOLVED <br />� .S%`T'.S •�'�•'1 <br />wt xooc <br />caam�cnoN ioiw <br />� <br />SHOWER <br />TELEPIId1E MMIEER <br />PREVENTERS <br />� <br />FOR OFFICE USE ONLY: <br />FHONTSETp�C1( RE�RSF.TBACN <br />U�1� IOT�PEA <br />IIEIGNTLIMIT�TION 1p piOWELLING <br />UNITC <br />REO'D <br />o�iE <br />FEE <br />)TAL S <br />f f <br />FEE S <br />SIDE SETBnCN <br />V�C�NT SIiE <br />❑YES p NO <br />SIZE OF BlOAR I <br />B�SEMENI <br />❑YES O NO <br />HEATING SVSTEM: ❑ GAS O ELECTRIC ❑ <br />CONTKT PERSON ANO PMp�E Fq <br />I HEREBY CERTIFY THAT 1 NAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOC4. LAW REODUTN(3 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOqIZED BY TME <br />ONMER OF THIS PROPERTV TO PERFORM THE WORI( FOR WHICM <br />APPLICATION IS MADE AND I COAIPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x qp,i2� L�n �,� 2 � �,6 <br />SIONATURE D�TE <br />BUSINESS LICENSE NO. <br />ivi.—�vnnu�u VnI1A" <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE IWIX <br />PUN CIIECN MIMflF.R <br />BIIIL�MG <br />PIUMBING <br />MECN�NIC�L <br />ADDIIION�t PL�N GNF.CN <br />oiHEn <br />SiAIE BUIIDING SIIRCN�RGE <br />CRV OF EVERETT ruenr, woaKs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />iEF nECE1Pf Np <br />VALUATON F <br />7 <br />