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�. ,-. <br />APPLICATIOA FOR CONSTRUCT.ON PERMIT <br />CITY OF EVERETT • BUIIDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 96201 • 259•8810 <br />❑ DEUAOUTION p C}OMBINA710N ❑ BUILDING �7 NIECHANICAL ❑ PLUAABIHG ❑ SIGN <br />PROJECT ADDRESS: ){ Z�(� j p,e /J� p R <br />•RCMRGT ON f1E51GNER MM �pONE55 C�tV Jin �NpNF <br />GENERIdLONtR�L10R nMAIl�DD11E55 Glv p�f PUONE CGTEIIC[NSE� \ <br />�X XEL i�f�G //_ /L �e`L�i���!}n'� 360 �>7y - $72) <br />MECHMIICALLONTRI1LiOR MMLAOOHE55 f.I1Y T�1' i9iDN[ ST�TEIICEN$E• <br />COlJ�'rPAC7vQ S�c/A-C T � � 5 <br />RUMMNGCONTRIICT(Ni MIU�11pq1E55 GIfY IIP PNONE $T�fEl1LEN5E� <br />.t�u:il�i <br />OESCRIlE MIORK AfA SOU�RE i00TApE MVOLVED <br />l0T BIOCK <br />. . CONSTRlILI1pI IOJW IENDER.1100RE55. TEIE%IdIE MIMEER <br />TYPE <br />WATER <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR. E7 <br />PERMIT f <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />iRONT SETP�LK RE�R SETBACN <br />USE20NE IOT�RE� <br />HEIONT LIMIUTI011 NO Oi DWELLING <br />UNIfS <br />FIRE <br />Gi� <br />SETB�CK <br />I v�C�NTSItE <br />OYES ❑ NO <br />SIIE OF &DGRI <br />❑YES ❑ NO <br />HEATING SYSTEM: ❑ CAS ❑ ELECTRIC ❑ <br />CONTACI PCHSON �ND FNOME NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6UUTINa CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TME NfOAK FOR WMICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS UW 1827 RCW AN� 296200 WAC. <br />x �'��1,�.,,. y -��-s� <br />516N�TURE �� � D�TE <br />CITY OUSINESS IIGENX NO <br />NC - NHNDLO UNfTS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />FIREPLACEINSERT <br />GAS FIpEPLACE <br />GAS iANGE <br />OOIIDMR <br />P111Y01HG <br />MfCN11NIGM. <br />�Op1IIONq. PI AN CII(GK <br />ou�en <br />su�e euno��+c sunc�unae <br />CITY OF EVERETT ruour, wonres <br />LOCALSALES <br />TAX CODE IS 3105 TOtAL <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE f <br />rEF I ner.FmT No <br />