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CIN OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />❑ DEMOLI710N ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />PROJECTADDRESS: %Tl/7 - %�.-�J.�.r�, . 'i�„,. . .. .. <br />❑ PLUMBING ❑ SIGN <br />� c=rJCmr-Tr <br />iEN�NT 4�II �IlOPf55 GiY 7�� Pi�ONE <br />ARCMTEGTOROESIGNER MNl WOf1E55 CIIV /iP PHpNF <br />2SCi�i7 �l��f= �c�.6�1 k�o�.-�dr���' �y�'oJZ ��'7-�Ls�7 Z"S�7.J�(,�c; <br />GENEMICONiM ipi M111�D011F55 CIIY 7—i�—pIIONE SqTEIICENSF� <br />MECNANICAICONTRl1C70R M�II�D�RF.55 GTV )IP PIIONE ST�TEUCENSE� <br />PWMBINGCONiR�CfOR M�IlA0DRE55 LIfV IIP PNONE STAfELICENSE� <br />oescniae ww+K �r+o <br />%%/� � <br />/� �� �Cn9sr <br />LEWL <br />�oT _ <br />voouee wvaveo <br />BLOCN <br />� i: <br />HEATING SVSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />r.oNr�ci vrnsoa �Hn rNor�e wo <br />F!lfT.�lalt .�'�-! i %� �.�7- /�T <br />: f I HEREBV �CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />�d ��i PROVISIONS OF LAWS AND URDINANCES GOVERNING THIS TYPE OP <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />eE�owoa�rti,cnrwocoriesl NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />_ or AUTHOHITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTNER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />— PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PEHFOPM THE WORK FOR WHICH <br />. � API'LICATION IS MADE AND I COMMPLY WITH TNE STATE <br />CONTRACTORSy1W 1B,7fijRCW AND 296.200 WAC. <br />CAHSTRtICiION IOAN lENOER. �OM1E55. 1ElEPNd1E NUMpER <br />NO. <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAH. ET <br />SUB TOTAL S <br />PEHMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK PE�R SFTB�CH <br />USEIONE LO1�HE� <br />IiE1GHT LIMITAiION HO OF OWELLING <br />UNIiC <br />OCCUPANCY 1q (1f5fOPoC5 OCCUP�NILO�O <br />G�3 � <br />AE <br />Si�E SFTB�CN <br />��C�Ni SItE <br />❑VES ❑ NO <br />BUSINE55 LICENSC NO <br />TYPE OF E06 <br />A/C —lVHNDLO UNRS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFEPLACE i <br />FIREPtACE INSERT <br />GAS FIREPIACE <br />GAS RANGE <br />GAS P�PING <br />EXHAUSTfAY <br />Pt AN CI IECR NUMOFO <br />OWl01Nf <br />512E OF BIOGrt I <br />3 6 S, F, riuunwr, <br />BIISEMENT � � MEC11eNIU1 <br />❑YES [[B"N� -- <br />•Dpi110NM. PI �N Cllf GN <br />OIIIEfi <br />SiME OIIIIDING SqRG11A0GE <br />CITY OF EVERETT r�mur, vmn�s <br />LOCALSALES — <br />TAx CODE IS 3105 Toin� <br />FEE <br />SUBTOTAL E � <br />PERMIT S —� <br />TOTAL FEE f J <br />�EF , � A/� REf.FIPT NO <br />i 'l <br />