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APPLICATIOrI FO�i CONSTRUCTrdN PERMIT <br />CITV OF [VERETT • EiUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT. WA 98201 • 259-8810 <br />I 1 DEMOLITION i I COMBINATION I i BUILDING � I MECHANICAL }7Q PLUMBING I I SIGN <br />PROJECT ADDRESS <br />owr�c� unu �nonrss cnr nr - rna�e <br />Stie..�s�c4. �ht�agt Api� %vl �s*'- 5� 5•£ Fi,w.�� �,.,A 3ss-8»� <br />t[N�Hr ' unn.nnnnrss cnr �in + rnnme – <br />nncrmr:ctonnesir.ven r�nneonn�ss arv - ,:u� rr�oNr <br />oeNenacoNinncron M�n.eonness cnr rm ruoNe saeuc[Nse. <br />MECN�NIL�LCONIRnCi0f1 AIAILnpptIF55 GTV ]IP PIIONf $lAiE11CFN$E� <br />PLUA'BINC C�O1NiR i1Oq 1 M�II. ApUf1E55 Cliv t IIP �1'�� L 1'HONEl' /�u Si�iE I.ICF.N1SE � 1' <br />U%11�'�il� ' ll.(iy11N1/1< �I��/�� l�,.r�- h�� S.C. W(N.1(�I�NYI�M � Wrt �1LL�Z�4li �1N�f�,e �lO�ZF <br />CONTR�Ci PNCF OP YIOfiK � � — <br />�Np SOU�RE FOOT�GF INVOLV[0 <br />��%Inl'�S ��0�' � ��L� W4i�L �I'N�(� <br />i� B��a � 9 U4��� 9'c.• qZ� q3 <br />9`Ice <br />LEO�L OESCRiPl10N O� PROPERTY �SMOYM NEIOW Ofl RTT�CII I WO GOPIE 51 <br />iot eiocK or <br />P�RCELT�XID NUMBEA <br />CONSTAUCTION LOAN LEN�EfI, �DOf1E55. TELFPHONF. HUMPFfI <br />PLUMBINO <br />NO. TYPE OF FIXTUHE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV�WASN BASIN) <br />SHOWER <br />/ KITCNEN SINK 8 DISP <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ET <br />SUB TOTAL E <br />PERMIT $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />fBONtSFTflFCR fl[RfiSFipACK 51�[SFTp�CN <br />UFC ZON! <br />I�[IONT UMIIATION <br />rrrE <br />IOI�RF� <br />NO OF pWELLINd <br />UNIiS <br />OCCUP�NItO�U <br />ncnsor� <br />RF�SON <br />ruNs RrrnovEo <br />UAIE <br />WL�NI Slif <br />iivFS i'. Nn <br />SIZE Of AlUU41 <br />MENI <br />nvrs n r�n <br />HEATING SYSTEM: I 1 GAS f 1 ELECTRIC f 1 <br />f.ON1AL'1 PI PSON �NO PIIONF NO <br />I HEFiFBV CERTIFY THAT I HAVE READ AND EXAMINED 1HI5 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL BE COMPLIED WITH N.'HETHER SPECIFIED HEREIN OR <br />N01. THE GRANTING OF A PEqM1T DOES NOi PRESUME TO GIVE <br />AUTHOPITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OF LOCAL LAW REGULATIN4 CONSTRUCTION OR iHE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED OV THE <br />OWNER OF THIS PROPER7V TO PERFORM THE WOHK FOR r1HICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1B.27 RCW AND 296200 WAC. <br />x l,t� , i,P� 3-19-9s <br />SIGN�IIIRE DATF <br />CIIY BUSINE55 LICENSC NO <br />NO. TVPE OF FIXTURE OR ITEM FEE <br />A/C — AMNDLG UNITS — H.P. <br />FORCED AIR SVSTEMS — �.T U. M E.A. <br />UNIT HEATERS — B.T.U. M <br />CIOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATEF <br />WOOD STOVE <br />METALFIREPLACEIWOODI <br />GASfiANGE <br />GAS PIPING <br />[%HAUSTFAN <br />SUO iOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />r�uunrn _ I reF I nrcrirr an <br />ounrn��r. <br />1'LIIMpWC <br />MfC11�NIC�I <br />nooinoNe� ruw cn[cK <br />on�en <br />SI�I[ OUIl01NO SUOQ11fiCP <br />CITV OF EVERETT runuc wan�s <br />LOCAL SALES <br />TA% CODE IS 3105 TOTAL <br />