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APPLICATIL.J FOR CONSTRUC7 JN PERMIT <br />CITY OF EVERETT • BUILDING OIVISION <br />3200 CEDAH STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION C�BUILDINd C�MECHANICAL �LUMBING O SI(iN <br />PROJECTADDRESS: 2�� �/ 3STN ST SLc/ EVEQE7'i <br />OMMER MNL�OOIIESS �1TY ZIP PHONE <br />JofFN UR$�N Po_ Box 6G6! Lv�V.v[qzoo,o wr}� 98o3G 7�/ -5729 <br />iE1UNT 1MIL1100RE55 CITY 21P vNONE <br />d10E91fiNER IA�IL �DOnE55 <br />fiENEMtCONTMCTOq MNL�DONE55 CITY Iif` PIIONE SIATEUCENSE� <br />T�H'N (JR $s�N P.6_ 8ax 66G! LYu.VcutbD wA� 9Bo36 77! -.r729 wESTWe/FOSSSF <br />,AIELNAN�CAlCON1R�CT011�, M4L�OOfJE55 CITV ZIP PHpNE ST�TEUCENSE� <br />CONTRAClOR <br />i�-:-.�*. ��i .-:�a <br />G <br />oescwee waa� �ra sou�ne woT�cse wvaveo <br />�oT � e�ocu <br />CONSiHlICT10N IOAN lENOER. Mq1ESS. IELEP110NE NUGBER <br />NO. I TYPE OF flXTUNE OR REM <br />f�i:ii►;:] <br />SHOWER L <br />KIiCHEN SINK 3 DISP <br />LAUNDRY'fRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKINCi FOIMiTAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRpfT5E7BACK RE�RSETBACN <br />��� _� <br />USEIONEI� � <br />�Kwt urNT�noN <br />cn�Y� a <br />3 u� <br />flRE SPRINKLEfl ilE�'1 <br />LOTARE� <br />� <br />Gur <br />FEE <br />PERMIT S � <br />TOTAL FEE S ' <br />SIOE SETB�C1c <br />30� d %•S� <br />VACANTSItE <br />>9 �ves ❑ no <br />no ar owewrxi <br />UNIiS / <br />G <br />:�rv� <br />❑YES NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />HEATING SYSTEM: Q�GAS ❑ ELECTRIC p <br />CON ��CT VERSON M!D PIIONQ !q <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 WILL 8E CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GtVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OFi LOCAL LAW REGUTATIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHOqIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CANTRACTOflS LAW 1827 RCW AND 296200 WAC. <br />X /,�,.�.. .�G�ilew ��G- zy, /996 <br />SIGNATU D�TE <br />qiV BUSINESS LICENSE NO <br />NO. I TYPE OF EQUIPAAEMT I FEE <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE (WOf <br />FIREPLACE INSERT (WO <br />GAS FIREPLACE <br />GAS RANGE <br />SUB TOTAL S <br />TOTALFEE S <br />CIIECK NUMBER FEF REf.EIPT NO <br />�iJn'�-� `; 97/3 <br />BUILDING S O� iJ G <br />' <br />PLUMBING O� <br />MECH�NILAL D i D� <br />�DDITION�LPLANCNF.LN � �r <br />iU�7 <br />O7HEd <br />i <br />SUTE BUIIDING SURCMI1fiCE � tl� <br />__ r <br />PIIBI lf, WORNS �, � � <br />TOTAL <br />