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APPLICATI�..� FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMIOLITION ❑ COMBINATION ❑ BUIIDING ,�AAECHAN.�CAL ja pLUMBING ❑ SI(iN <br />PROJECT ADDRESS: ��� '�� n������ �������(� � <br />V <br />oE� v�onc �wo <br />ioT xaac <br />MIILELTNf1.D.MMlER �" <br />CONSiPULT10N LOMI LENOER. <br />uui �ooa¢ss " <br />r+ui.nd+ess <br />� <br />� <br />Mui�oo�ss � <br />� <br />Mui�ss <br />1 'L.Z_ <br />Twe r+vaveo <br />a <br />SHOWER <br />KITCNEN SINK 8 <br />dSHWASMER <br />LAUNDRY TRAY <br />q.OTHES WASHI <br />FOR OFFlCE USE ONLY: <br />�na+r sereacK r+�u� sere�cK <br />� <br />IIEIGNT UMT�TION <br />IOT�RE� <br />�+o ov owEu:rxi <br />UHIfG <br />D�TE <br />BY <br />MIMEER <br />FEE <br />SI�E SETB/�Ck <br />FEE <br />V1ICNIT $ITE <br />❑YES ❑ NO <br />512E OF BlD6R1 <br />OYES O �+o <br />CITY OF EVERETT <br />LOCALSALES <br />TA)( CODE IS 3105 <br />PNONE <br />:m <br />HEATING SYSTEM: ,�I GAS ❑ ELECTRIC ❑ <br />CdiT�TFER50NMqPllplElq , _. � ,. • <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILL BE CJMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION Of ANY <br />OTHER STATE OR LOCAL LAW RE6UUTINO CONSTRUCTIOh OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNOqIZED BV THE <br />ONMER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I�OMQLV WITH THE STATE <br />CONTRACTORS L 27 R [T2962 6 WAC. <br />z � <br />SIOMl1 D <br />p7Y BUSINESS 110ENSE NO <br />� <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />RANGEHOOD <br />WOODSTOVE <br />MEfAL FIREPIACE I <br />FIREPLACEINSERT <br />i'UNCIIECNNUAIflER fEF <br />S'i`'f.` r <br />BWIDING <br />PUIMBING <br />MECH�NIC�I <br />�pp110N�L PUN CNfCN <br />O1NER <br />Si�i[ BIIIIDING $IIRCN�pQE <br />ruBl lf, WM+NS <br />TOTAL <br />SUB TOTAI S <br />PERMIT f <br />TOTALFEE f <br />