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APPLICATIC J FOR CONSTRUCT..1N PEi�MIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 253-8810 <br />(�� DEMOLITION ❑ COMBINATION O BUILDIN� M MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADORESS: 3PVS S� �t p1• 5.�,/ <br />i <br />JcM{, P���:A el 3cos �is PI �.✓ t✓e�ri� 95'ia3 3ss �3roS <br />OM'ME� MNLI10p1E55 CITY z�p pNpryE <br />TENN�T M/JI/�DIX1E55 LITY 21P PIIONE <br />ARLMIRCTOfi�E516NER WILADDRE55 Cltt )m PHONE <br />GENERAICONTNALTOR M�IUDpRE55 CIfY )IP PIIONE $UTE:ICFNSE� <br />MECHANICA�CpNTMCTOR MAlLA00RE55 GTV ZIP PNONE $TATELICENSE• <br />"JFrsl��n 5�..�-� Sl�ar�- /Vi¢'�Rj y,,, p.� 5,,��5�8 L✓• GTS�vb 2Sz-3iiH t✓L'-RGS-S�xlk� <br />PLU MIGCONTRACTOiI MML1100qE55 CITY zlP PHONE $tATELICENSE� <br />Sd1ARE <br />r�S�'AMcQ- <br />l4WL OESCRIPTION OF PROR <br />�o; e�acu <br />PMCEL TA% I.D. MIMBER <br />MlVOLVED <br />CONSIRIICTIp/ LOM! LENDER.AOORESS. TELEPIIONE M/MBF.f1 <br />NO. TYPE OF flXTUHE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />SHOWER <br />LAUNDRY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK ISERVICE — <br />SUB TOTAL <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FqONT SETBACN PE�R SETBACI: SIOE SETBACH <br />USEZONE LOTAREA VAC�NISITE <br />❑YES O NO <br />NEIOHT UMITATION NO OF DWELLING SRE OF BIDGR.I <br />UNIT$ <br />QYES ❑ NO <br />HEATING SYSTEM: LS�GAS O ELECTRIC ❑ <br />CONTACT P�FR,SON NID PHONE NO <br />J+Q PFroli.T�� 7�1•2�IM <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF UWS AND ORDINANCFS GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHE'IHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY <br />OTHER STATE OR LOGAL lAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONiRACTORS LAW 1827 RCW AND 296200 WAC. <br />x Y.�v �,l�u-�. �„ .l I.t • i o� 9� <br />SIONATUR D�TE <br />CITV gU$INE55 LICENSE NO <br />NO. � TYPE OF ECUIPMENT � FEE <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYERS <br />RANGEHJOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE ( <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RAN6E <br />PUN CIIEGR NUMflER <br />OUILOINC <br />PLIIMBINC <br />MECH�NICAL <br />�OOI11pN�L PIAN CHF.CN <br />O111Ef1 <br />STqE BURUINC SIIRCINqCE <br />TYOEOFf;ONST PlANSAPPROVE08Y CITYOFEYERE7T �IIAIIf,WOfiKS <br />LOCAL SALES <br />o�,F TA% CODE IS 3105 TOTAL <br />SUB TOTAL f <br />PERMIT f <br />fEF I �FCEIPTNO <br />