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APPLICAThA FOR CONSTRUC', AN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA Ot • 259-88I0 <br />❑ DEMOLITION ❑ COMBINATION ❑ Bull <br />DING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: -31.2,) A 2rl1T <br />I1gCN1ECT OII pESIDNER N1Ul ADDRESS <br />tltt NIP PHONE <br />CONTACT F"mawollll •7� I HEATING SYSTEM: P11'.AS ❑ELECTRIC ❑ <br />DEfC11OE WOW AND SOIM111E AGE INVOLVED CONTACT PER$d1 A/R)P/IdK NO <br />LOT MOCK <br />101w lE1QU �OOIIEff IFIFEFIOE MIYEA <br />URINAL <br />pwam FOUNTAIN <br />FLOOR DRAIN <br />BACKIFLOW PREVENTERS <br />9M (SERVICE — BAR. ETC ) <br />SUB TOTAL f <br />PERMIT f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />.•rt wmvTYC- <br />W JOHT IMTATION <br />1 OI AREA <br />40 OF Ow[LIP <br />UPTS <br />UATL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNM THIS TYPE OF <br />WORK WALL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR ORMANCEE OF CONSTRUCTION. THAOCAL LAW T <br />CONSTRUCTION OR THE <br />PERFORMANCE I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COSY WITH THE STATE <br />OR S u e 2T <br />X D„E <br />an wyrss ICFNSE No <br />SIDE SFTYC• <br />VAC1W T ytE <br />❑YES ❑ O <br />TAi OF RDon I <br />oy" ONO <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 310S <br />SUBTOTAL f <br />PERMIT f <br />TOTAL FEE f <br />n AN alFc• NIMII N <br />M CwwIICAt <br />AOfYttONN M1AN VV to _ <br />gUl[P — <br />STAlt RIMCt"K SPCHAIIGf <br />n 19nr WfMtnS <br />TOTAL <br />