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: ��-, r- <br />APPLICATION FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETf • BUILDING DIVISION � <br />3200 CEOAR STREET • EVERETT, WA 88201 • 259•8810 <br />❑ DEMOLITION ❑ COMBINATION '/ ❑ BUIIDINO, /, �/M'/ECHANICAL ❑ PLUMBING ❑ SION <br />PROJECT ADDRESS: ,� (>Li� I"�lU Y � /V � U( ' � R �Q� <br />icHeHr C - u�n �nonrss <br />l��'1 � <br />�i1CMTCC UESIONFN M�il MO�E55 <br />r.n��/�� .,,. <br />�`�"7—.'iiv <br />im nr <br />cnr —�--� nr <br />�C S <br />r.�' — nr <br />IYCIL9f <br />P110NF SI�IE L�CENSE r <br />MU4BMlG CONIRAf,IOR M�II �IXMES� "fltV �� JI� 1'110NE STIITE IICFNSE � <br />CONiR�GT PPoCE OF MqPN d/ — <br />jj HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OE9CMlE NpIN �ND SOl1ARE fOd AOE 1NVOlVE� f.(NIi�CI �f115QN �N`� lllpl(,/-q, �, <br />. —�-��11�4L 1� A�t' <br />/.../-n �alll i'hois��/_.,�,r..�r 7AZ-U�n,� <br />PIIOI'OSEO USE OF BUILdNO <br />LOT BLOCM <br />CONSf11UGT10N101W IENOEq,�Od1E55. TElEP110NE MMBER <br />� <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />URINAL <br />DRINNINO FOUNTAIN <br />FLOOR OiiAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />i110NISETp�CN REM15iTR�GK <br />U4EIONE IlOf�11E� <br />NEIONTIIMIt�fION N00%OWEIUIq <br />UNIIS <br />OGCUP�NCY Iq (x SIfMb(5 OLCUPANt IO�D <br />FIRE FPRINKtEfl <br />TOTAL f <br />SIUE SETB�CM <br />VAC�N� SIfE <br />❑YES ❑ NO <br />SIIE O� BlOOrtI <br />❑vFi ❑N� <br />CITV OF EVERETT <br />LOCAL SALES <br />TAX C0� i IS �105 <br />I HEREBY CERTIFV THAT 1 HAVE READ AND ExAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNE ORANTINQ OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVI510N OF ANV <br />OtHER STATE OR LOCAL LAW REGUUTINO CONSTRUCTION OR THE <br />PERFORMqNCE OF CONSTRUC'ION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS P RFORM THE WORK FOR WHICH <br />APPLICATION M ND COMPLV WITH THE STATE <br />CONTRACT L CW A 298200 WAC. <br />SZON�TUnE �iE � <br />CIIY BU9NESS IICENSC NO <br />NC — AMNDLO UNRS <br />FORCEDAIR SYSTEMS <br />HEAT PUMP <br />WOODSTOVE <br />METAL FI(iEPIACE � <br />FIREPLACEINSERT <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />PIANCIIEf.NNUMflfO �fFf ��r.em�rro <br />pltllpMO <br />Pl11YpIN6 <br />M(CIUNIC�I <br />•OpIIONq PI�N GIff.M <br />OblEn <br />SIAI[ fl11RaNf SII�f����6E <br />ri �ni v, wrni.s <br />TOTAL <br />FEE <br />