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APPLtCAT10.,� FOR CONSTRUCTI JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA eB201 • 259•8810 . � <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING O SIGN <br />PROJECT ADDRESS:_ ,�/ J/ � ��,9c"� l�t%, <br />OMMER 4u11100qESS CITY Ilr <br />/ �'i �`i ve� �, i �ii�,G,T �iSZ��rz 7-�-�- <br />iEWWT <br />MCN7ECTOROESIGNFR M1UlADD11E55 CIIY /II' P/qNE � <br />OENERILL CONTMCidi IM1l A001�555 GIY —� ]If' PI10NE Sf�TE IICFNSE � <br />1EpIM11G1lCONTMCTOR WWMLwE55 G7Y IIP P1qNE STATEIA:ENSE/ <br />�2 <br />PlUM1�M�iCONiIUCTOR YMLAOOFESS GfY IIP PIqHE SUTElKfNSE• <br />OE6CIIME WOf11(A/O SOUAiIE FOOTAOE NVOWED <br />�o�u oescwrrron a mor� <br />LOT llOCl( <br />COP1E5� <br />SI.D.iN1qBER <br />'�710N LOAN LENOER. ADp1E55. TELEPIIONE MIMBER <br />� <br />TYPE OF FlXTUqE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOYYER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDRY TfiAY <br />CLOTHEB WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETC.1 <br />SUB TOTAL S <br />FOR OFFICE USE ONLY: <br />iiIONT SETBACI( REM SETMCN $IOE SETB�CN <br />u5E20NE ILOtME� <br />IIEIOHTl1W7ATION NO Of DWELLIN6 <br />UNIIS <br />OCCUPANCY NO OiS�(wF5 OCCUPANTlO�D <br />HEATING SYSTEM: I�I GOS O ELECTRIC ❑ <br />GONf�CT PLRSONMID PIIp1E Iq � 7�7 _ 7// <br />1 HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION �ND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED IIEREIN ON <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUUTIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THA71 AM AUTMORIZED BY TME <br />OWNER OF THIS PROPEHTY TO PERFORM TNE WORK FON WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TME STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />�— <br />��� � r�— ����� <br />tU11E W1E <br />GTY BUSINESS LCFNSC NO <br />MECNANICAL <br />NO. TYPEOFEpU1pME11T FEE <br />aa: — an�un n � iurrc �—� <br />HEAT PUMP <br />UNIi HEATERS <br />CLOTHES DRYERS <br />RANGEHOpD <br />WATER HFATER <br />WOOD STOVE <br />MEfAL FIREPIACE 1 <br />FIHEf'LACE INSERT <br />GAS FIREPUICE <br />GASRANGE <br />GAS PIPING <br />SUB TOTAL S : <br />S <br />PLANCIIECIfNIIMBfH �FEF �RECEIP(NO <br />VACANt51IE <br />❑VES ❑ � BUIlU1Nf. <br />SIZE Oi Bl00lf I <br />PLII/MINC <br />B�SEMENT MFbiwiC�� <br />�YES ❑ NO -- � <br />��5� AbIAIION. .n(CN <br />ouirn <br />r��,aoN — <br />STA: �u 51111C1ufKE <br />O�tE <br />CITY OF EVERETT ruei i� �s <br />LOCAL SALES <br />TAX CODE IS 3105 iOTAL <br />