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APPLICATIG'�i FOR CONSTRUCTi�JN PERMIT/ <br />CITY OF EVERETT • BUILDING DIVISION tlC���� <br />3200 CEDAR STREET • EVERETT, WA BB201 • 258•8810 � <br />❑ DEMOLITION ❑ COMBIINATION ❑ BUILDIN(i O MECHANICAL �PLUMBINQ ❑ SION <br />PROJE�TADDRESS:���� �"Ljyr'� �. ��(��YtTI c,Gu�c- 5t�(�L=7'l�hKt� <br />ONMER M�RMORE54 Ciiv i�r PupHt <br />.�Ll���-►T l'�.it�ic. ��59ct I-�t;�i m/� �I�,Ti 33�-54�0 <br />iF1UN1 YNLMd1E55 f.I1Y )IP PIqNE <br />11RLMRCT (MI OESI6NEA MNI MOfiE55 GIIY 71P PIIONF <br />- �,�) , � i �' S U h'!l. s' 3/ 7.5 (C I i°_�i�%� <br />OE �UICONfMCi 4u1A0011E55 � CIIY )? 'p�ONE 51�TElKFNSE� <br />�J�l(71(Ji.� (�LI�T fG rl �j11 1� A• <br />MELNANIGLCONTRAC70R MuIA�DRE55 qtt 7iP PIIONE ST�TEIICENSEi <br />�,� - If�(,�," �PLuI-IBII�A� ��'F�c� NC� I Z'1 `l C l IZ r[Ar1i� �;(o h Z-{ ' 1 Z6Z �aeeYVElo27� <br />AVMlNOCONiR�ICiOR wIL�UDnQSgT LIfY I�P PIqNE Sf�TEIICFNSE� <br />�or <br />NORN �NO 6q1AilE i00TME INVOLVED <br />e�aca <br />�OORESS.IELEP110NE NUMeEP <br />WATER CLOSET <br />BATHTUB <br />UUNORY TRAV <br />CIOTNEB WASHER <br />DRINK�N6 FOUN?AIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />SINI[ ICFGVICF _ I1♦ <br />[�::li 1 i"� <br />PERMIT f <br />TOTALFEE S <br />FOH OFFICE USE ONLV: <br />i110NT9ETB�L1t PEMSET&1CK <br />U8E ZONE IOT�RE� <br />NEqHi UMITATIp1 /q pF DWElUNO <br />UrnIF <br />nvE a r,orisr - <br />FEE <br />SIOE SETBIILN <br />WLANI AIIF. <br />❑YES ❑ No <br />ei� a e�oort i <br />B�SEMENI <br />❑YFS ❑ NO <br />HEATING SYSTEM: ,�GAS ❑ EIECTRIC ❑ <br />conucT rcnsa� nrm a� uo <br />� HEREBY CEHTIFV THAT I FIAVE READ ANO E%AMINED THIS <br />APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISION5 OF LAWS AND ORDINANCES 60VERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED MEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHEH STATE OR LOCAL LAW qEQUUTIN4 CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TNE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE BTATE <br />CONTRACTORS LAW iB.27 RCW AND 298.200 WAC. <br />5 NAiUnE ] �i�� IC! � � ` — D��E l � I �C�— <br />� � Z 7�) <br />CIfYBU91NE5SlSENS[Np � <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />�a.�y�i�r,ra <br />TOTALFEE S <br />Pl11NC11ECMMIMpf7 fEF �Ef.fIPINO <br />'� /�(�oL <br />OItlIbIN(1 <br />�111M111N(t <br />MFf.IUMf.M <br />�D[N IION�L 1`I �N C�If GM <br />OIIICII <br />SIAIE 9UIl��Nli SIIIK:II�II(lE <br />CITY OF EVERETT ri�ai�cwon.s <br />LOCAL SALES <br />TAIf CODE IS 3105 TotAl <br />FEE <br />