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APPLICATI� 1�1 FOR CONSTRUCi .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA �38201 • 259•8810 <br />fl DEMOLITION O COM8INATION ❑ BUILDfNG ❑ MECHANICAL O PLUMBING ❑ SIGN <br />"� � FIIONE SfAIEIILENSE� <br />__ "_"' __""_" ..... �..n �nnnccc � CIIY lIP <br />STA7E IiCENSE � <br />MECHANICAICONTRACTOfI MAIL�DD�lE55 �•"' "' - <br />PWMBwGCONiRACTOf1 MAILAODFlE55 CI�Y ZIP PIIONE $TAIELICENSE� <br />PAIGE <br />OESLflIBE WORN I1ND S�UARE FOOTAGE INVOWED <br />X <br />USE <br />LEGAL OESCIIIPIIUn �� rn�n <br />LOT BLOCK <br />CONSTRIICTION LOAN LEN�Efl, AOOfiESS. TELEPMONE HUTAOER <br />PLUMBING <br />OF F IJ(TURE OR ITEM <br />KITCHEN SINK 8 DISP <br />BACKFLOW <br />SUB TOTAI S <br />PERMIT 5 <br />TnTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETO�CN REAR SETBACK <br />/� � o <br />USE20NE LOleOEA <br />�' / <br />IIEIGIIT LIMI1A710N NO OF UWELLING <br />-^ UNIfS iy <br />% V <br />OCCUPANCY NO Oi510PIE5 OCCUP�NTLOPO <br />N� <br />E ALMhI flE0'D <br />NB <br />re oF r,o�+sr , <br />/ <br />� .� IV <br />� <br />FEE <br />SIOE SEiBACN <br />�C7 <br />V�C�Nt SIiE <br />SIZE OF <br />���,�C � 7 <br />DAIE S �� <br />� <br />� <br />HEAfING- -SYS�T-EM: ❑ GAS ❑ ELECTRIC ❑ <br />MNLAf.iPElISONANDPHONENO / ._ /, <br />I HEREBV CERTIfY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND I(NOW Tflc SAME TO BE TRUE AND CORRECT ALL <br />PROV!SIOIJS OF LAWS AND ORUINANCES GOVEHNING THIS TYPE OF <br />WORK WILL OE COMPLIED WITH WHETHEF SPECIFIED HERE�N OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOflITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LA'N REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFIUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEfiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I, COMPLY WITH THE STATE <br />CONTRAC ORS LAW 1027 HC� 296.200 WAC. <br />� � � � %/ � � � - �c5 = �' <br />� � i..� <br />SIG61 N DAIE <br />CIN OUSINESS LICEYSL NO <br />MECHANICAL <br />NO. TYPE OF E�UIPMENT FEE <br />A/C — A/HNDLG U� <br />FORCED AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTNES DRYERS <br />WATER HEATEF <br />WOOD STOV[ <br />METAL FIREPIACE � <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />EXHAUST <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE 5 <br />PlANG11ECNNUMI1Pf1 � fEP IPECE��'TNO <br />❑YES y. ••- pUIIDING <br />OLDGRI <br />I _ �q vwuoirur. <br />U � <br />15EIAENT `/_ MECIIANIf.AI <br />❑YES /LJ N�' <br />noonia�+ai. r� nr+cnccK <br />on�[n <br />STA1B OIIIIUUIfi SItl1C11AflOE <br />CITY OF EVERETT rumir.wnnns <br />LOCAL SALES <br />TAX CODE IS 3105 707AL <br />