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APPLICATIOrr FOR CONSTRUCT�.�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION GC���� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 � ��Rr� <br />I i DEMOUTION f i COMBINATION r i BUILDING ��MECHANICAL i i p�UMBING I� SIGN <br />� PROJECT ADDRESS y <br />u�cwrrc�oi+aesicNrn M�u �nnnFss —� <br />GFNFfVIf,pNfpPR(Nl MRII�p�MEtiS <br />cm <br />utv <br />❑�v <br />rir rnoN[ <br />J • �� �l9YJ/L/ � �S o y �_ <br />1ia rr�aNF <br />,�� ��"�/' o? 9-��? <br />rHONF <br />)�� PIIONC $Gtf I ICENSF r <br />LONTR�CIPPICEOf Vp11N - _ <br />HEATING SYSTEM: I i GAS � I ELEC7RIC f I <br />DESCPIBE VIO(1N �Np Spp�pi Ff�1�GF INVDIVEU f.ONi�CI Pff150N �Np PI�ONF NO � <br />/�n.Gr✓JJi ,/��.2-�n.i � ._.^o.r�. .� " _ <br />lEO�L DESC111PTION pF pfpi'Epry �SHOWry BELO� <br />iot niocK or. <br />PIVIGEL TI1M 1 D MNBER — <br />CONSTRUCTION IOAN I.ENOER. Ml(ME55. TEIEi'NONE NUMPEfI <br />PLUMEINO <br />NO. TVPE OF <br />WATER CLOSET� <br />SHOWER <br />_5 WASHER <br />VG FOUNTAIN <br />DRAIN <br />SUB TOTAL E � <br />PERMIT E —� <br />TOTAL FEE E ~ <br />FOR OFFICE USE ONLY; <br />fRONT SFiP�f.N RF�f15FIP�f.N <br />USi20!If IOTME� <br />NEIOIIIUMIGTION �10 Of1�WfILI!u <br />IINIIS <br />OCCUP�NCV NO M1 Stl�FiFS (%:GIIIMM L0�0 <br />nnam <br />FIRE�IMiMRFO� fIF45pN <br />rinv <br />n�rc <br />I HERE�fV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE iRUE AND CORRECT ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOVEiiNING THIS TVPE OF <br />WORK W�LL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE ORAN71N0 OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REOVLATINO CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCfION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS P(iOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTOR$L1W CW AND 296200 WAC. <br />�- ='�__ l-/,?� 9s�. <br />SIA�`1�7URE ����E <br />f,ITY BUSMF.SS 110ENSC NO <br />7YPE OF EOUIPMENT <br />A/C — AMNDLO UNRS — H.P. <br />FORCED AIR SYSTEMS — B.TU. M <br />HEATPUMP <br />I1NIT HEATERS — B.T.U. M <br />VEN7ILATION FAN � <br />RANOEHOOU `. ��. � <br />WATER HFATER , <br />WOOD STOVE i — <br />METAL FIREPLACE (WOOD BURNING) � <br />FIREPLACE INSERT (WOOD BURNING) — i� <br />GAS FIqEPLAGE <br />Jn� IIMI��]L � <br />OAS PIPIN(3 —�--�— <br />EXHAUST FAN , <br />SIDESFiP�CN PI�NCIIF NUIML� fCF <br />�.. ) ,'�J �i <br />vecnr�� srtr FEES <br />i � rrs � �. Nu <br />Allil UMG <br />SIIF Of q� fKRI <br />PI ilMfl W fi <br />P�SEMENI MffAUNIGI <br />livF9 ��ry0 - <br />•INlll IONN PI �N CII(f.N <br />- ___ OIIIFR ( � ��.�� - <br /><in�F nu n^�r sunc�mnr.c <br />CITY OF EVERETT rvim ic wnnKc <br />LOCAL SALES ---- -- <br />TAX CODE IS 3105 7otAL <br />SUBiOTAL S <br />PERMIT E <br />TOTAL FEE S <br />❑ff,Flnt NO <br />