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APPLICATIC. . FOR CONSTRUCT►JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADORESS: lo�Q�l Z,/�Q_, (� <br />owwER MAll�00RE55 cirv I�r m�t»+[ <br />� <br />1;A�•1: �.% `'>il'.IF-Y'"FCLLCC� %�i��Z I�✓(�I��II11�C U1. L�C� I I.1��C� .'��_ �.� � I �� <br />�--- <br />lEW1Nl MN��OOPE55 f,IIY l�P f9�ONE <br />�i1CMiCCTdiDESM.NER M�I11100f1E55 GItV I�P PNONF <br />il�h�i, <br />GENE11�1 LONIfUGfpi Y�Ill1IXI0E55 f.IIY l�f P�RNI[ SIQE lIC[NSE • <br />�nr�c <br />MECHANIC/�L CONTR�LTqi MNL �DDRE55 CI1V )If` P110NE ST�iE UCENSE � <br />RUMBWGCON7R�CTOR M�IL1100RE55 CItY <br />CO11fMC� PpICE 0� MIO�N /� ^ ' <br />) '^ <br />OESGRIlE MI011K �ND SOU�NE FOOTI�OE IHVOtVEO <br />Pf1pPp5ED USE OF <br />�r��:�k �" <br />LE6�LDESCRIPTION V110PERiY13NOMMBELOWOR�TT�LN <br />NoaTM nu� <br />ioT �1_ e�ocK 3 . a B Jf RL} <br />39z8- 0o_5=0i1-oz <br />CONSTilUCT10N lON1 lEN0E11. Md1E59. TEI EP1h711E NVMBER <br />ITGM <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCNEN SINK 6 DISP <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ET <br />FEE <br />SUBTOTAL f <br />PEHMIT f <br />FOR OFFICE USE ONLY: <br />fRd1TSETRACK PEMSF7 <br />—1� � � <br />USE TONF.� � � � oune� <br />NEIOIIf UMI1�TIyN NO pi UWELLI1q <br />Z/ � UNIfS <br />OCCUPANCY NO (M S�MfS O(:CUPANI IO�U <br />��_ <br />SPRINKLER <br />SIDE SFTB�Lk <br />V�L�NI SIIF <br />❑YES ❑ NO <br />S�IE Or B100R 1 <br />❑vF5 U <br />PIqNE SfRE IICENSE � <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />r.�t�cr rrns� �Hn r�e ra <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT ALL <br />PFOVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE Of <br />WOHK WILL UE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br />NOT. 1HE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI'V TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR IOCAL LAW REOULATINO CONSTRUCTION OR'NE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW IB27 RCW AND 298200 WAC. <br />� ;�,,,��1�'l�� s-3�-96 <br />S.GN� f1E y �� O�TE <br />CITY 6USINE55 LICENSC NO <br />NO. TYPE OF EOU <br />A/C — AIHNDLG UNRS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORYERS <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPIACE INSERT <br />GAS PIPING <br />EXHAUSTFAN <br />PI�Nf.11Ef.NN11 f11 <br />/ <br />'�i. ��; <br />p1111I11N1: — <br />�IIIMIIINO - <br />MFI'l1�NIfM <br />♦OIHIION 4 PI �N GR fM <br />owrn '-- <br />suir nunowa wncwnr,c <br />CITV OF EVERETT rum �c w� �•�.a <br />LOCAL SALES -- --- -- <br />TAX COOE IS 31U5 7o�wL <br />BURNING) <br />SUBTOTAL S <br />PERMIT S <br />rcF ' / nrr.rrr� No <br />)Y. � L7 <br />FEE <br />