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� � <br />APPLICATitir�l FOR CONSTRUC7 �ON PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 �—�' <br />O OEMOL.ITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL PLUAABING ❑ SIGN <br />pRWECTADDRESS: CU �� ��AfM SF �IIC�/�-v�� G�/ <br />OWNEH ` ,, M1' <br />�oi <br />D �� <br />iLM//ORE'A55 /�� <br />v ,v <br />a�ooaess� <br />1� <br />E FOOT E wVOLVED <br />s;nl< - Cr <br />apc: q0.t�� <br />� " J <br />r�av¢nn �aavm ee�ow on �n� <br />e�ocu � <br />CpLS�p�f.T10N IONI LENOER.IIDDRE55. TELEP110NE NUAIBER <br />NO. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />/ LAVA?ORY (WASI <br />KRCHEN SINK 6 DISP <br />OISHWASHER <br />UUNDRY TRAY <br />FLOOR DR/ <br />BACKFLOW <br />— BAR, <br />FOR OFFICE USE ONLY: <br />F110NT SETB�LK NE�N SETB�LN <br />USE ZONE <br />NENiHT LIMIT�TION <br />OCCUPANCY NO ( <br />REO'D <br />SUBTOTAL S <br />PERMIT f <br />TOTAIFEE S <br />IOT�REA <br />rw arowe�unc <br />UNITS <br />o�rE <br />J <br />Gtt I Z� <br />cn ' nv <br />cm zm <br />CITy III` <br />cm ziv <br />FEE <br />SIDE SETB�CK <br />V�CANT S�TE <br />❑ NO <br />PNOHE <br />50.me � ,� '� — <br />21P vrvnc <br />SGTE IICENSE • <br />STATE IiCENSE � <br />STATE LICENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />c I�iClrGr�dl���L�Pt�'�J�e� P/l) <br />-' :;5,�- �1795 <br />I HEflEBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AkD CORREC7 ALL <br />PROVISIONS OF UWS AND URDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE 6RANTIVG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO V�uLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE O'� CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIF PROPERTY TO PERFORM TME WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />/- /[ i/.�Y1�.C., !� 7�r9Yt'�ii� 07 Y.C� <br />��T OI1TE <br />qTY BUSINESS IICENSE NO. <br />N��� <br />NC — NHNDL� UN <br />FORCED AIR SYSTF <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />WATER HEATE <br />WOOD STOVE <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE S <br />o�AN CIIECN NUMBER �EF I REf.EIPT NO <br />❑YES BUIIUiNfi <br />SIZE OF Bl061f.1 <br />PWMBING <br />��5 � <br />BASEMENT MECHeNICeL <br />❑YES ❑NO <br />AD01lION�I ��AN CNF.CK <br />OTHEN <br />S7AiE BUILOINO SIIRLHAROE <br />CITY OF EVERE7T rueiir.wo�Ks <br />LOCAL SAIES <br />TAX CODE IS 3105 TOTAI <br />