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APPLICATIOi�ii FOR CONSTRUCT�ON PERMIT�� <br />CITY OF EVERETT • BUILDING DIVISION C%V�_ <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 ���� <br />❑ DEMOLITION O COMBINATION O BUILOING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: � � � U S�O /� �9 /� � �p <br />OVmER uutMOnEss c�iv I�r vNprt <br />IEtUNT M/Jt/i00HE55 GTY IIP VIIpNE <br />�qLMTEGTORDE5IGNEP /MIlM0�E55 Cltt I�P PIqNE <br />GENERI�I CONiMCIOq M�Ill1W11E55 GIIY I�� 19�ONE SGfE IICEHSE � <br />E.[.rez PAc .�,L. <br />MECMNIIC/�LCONTMLTOii MNlA00RE55 Cltt IIP �'�10NE SiATEII�ENSE� <br />Co7J'7�Q /} C7p R -S�E�"i A t- T i SC <br />PlU4DRM CpJIR�GTdi M�IL�DIX1E55 GtY IIP PN(k!E ST�TE LICENSE � <br />S - l.� ni [ <br />vnoroseo use or eu�arut <br />�trv�) Q'h <br />�a� oescwrnar a v�+ortan �s�avm ee�ow on <br />�ot e�acu oF_ <br />PNICELTl1%I.D. NUYBER <br />CONS7IIIICTION IONI IENDER. �OOIIESS. IELEP110NE I <br />BATHTUB <br />LAVATORY <br />SHOWER <br />URINAL <br />DRINKIN� FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />i110NT5ET8�LK RE�R SETB�CK 90E SETB�Ck <br />VSE ZONE <br />NEIGNT UMIT�TION <br />OnC�l1NCY NO d 5 <br />FIRE SPRIKKLEfl REO'� <br />l0T AREA <br />NO OF DM/ELUNG <br />UNIIi <br />o�tE <br />WC�Nf SITE <br />OYES <br />sze a e�aorti <br />FEE <br />m <br />❑YES O NO <br />HEATING SVSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONTIICT VERSON N1D FMONE NO <br />I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WMETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6UUTINa CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND 1 COMPIY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />%L - �l-�2-ri� <br />51(NUTURE � D�TE <br />CITY BUSMESS LICENSE N0. <br />MECHANICAL <br />NO. TYPI <br />FORCED AIR SVSTEMS <br />HEAT PUMP <br />FIREPLACE INSERT (WOOD BURNING) <br />`r GAS FIREPIACE <br />GASRANGE <br />GAS PIPING <br />IXHAUSTFAN <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />PUH CIIGCN NUMBEP _ (EF RECEIPT NO <br />OUIl01NC <br />PlUY01NC <br />MFCN�NIf.M <br />•ODIIION�I. PUN GIILGR <br />on�cn <br />$L�IE BUIl01NA $U�CIUROE <br />CITY OF EVEREIT runnr. wonres <br />IOCAL SALES <br />TAX CODE IS �105 toiAL <br />