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APPLICATIA FOR CONSTRUCTIN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />?5AS L T, IL55 J 3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 �/ <br />❑ DEMOLITION H COMBINATION' ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS :79Iq 960l� at LIVQ -- _ - l-1 1-1l„1 <br />-- <br />ifN•N1 <br />YY Y Dwlts Grr lN' rNUNE <br />S1C7rX e.Lv4cS Icl(S WIL�+nISol� ?S'T-aS31 <br />•M.MIIG LV,fP = AA• f54 ^ G1Y <br />-J Qn--IFI'Z. TI fCT/? (-k ii17 CSJI <br />RJ <br />a-q I� <br />(nrP•CIUP 4•P <br />LN A <br />IrP•f.IGI 4•P <br />(S� <br />ON N"°" <br />HEATING SYSTEM: GAS ❑ ELECTRIC Cl <br />Pf SCaer W.]11w ANn', wrrrlOrwFNMAD <br />cWvcrnPEON•M %fYlr ND <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEE. _ <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AL• <br />I�aroua Inf �K elwdMl <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OP <br />HGAL PFSCPIPTION o N OMI"M ISNOYM MLOLN OPmKN lrmcalEsl <br />NOT. THE GRANTING OF A PERMIT DOES NO PRESUME TO GIV- <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />to, '7 elotll ,s-1-AL gs <br />OWNER STATE OR LOCAL TAW REGULATING CONSTRUCTION OR TI1E <br />`_- C <br />J'- 55- 7 <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZER BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK TOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />p'--"i435-� 1 az-mo <br />OF <br />GONTRACTO WI 827RCWAND295200WAC <br />IwlCn rLr 1 o MwIMP <br />S- do <br />(SIt1R,ICrNN 1OANIfM1FP AOPr,L55 Lf l(A,OIF NUMIIFrI <br />slr%Ar oArF <br />/ t� 11 �' <br />G1Y W41A 441[[Nw NO <br />PLUMNG <br />PLUMBING <br />FEE <br />NE^NANICAI <br />N0. TOF EOUIPMEM FEE <br />Np, TYPE OF FIXTURE OR ITEM EM �'—&RAE <br />WATER CLOSET (TOILET) <br />"DUG .. <br />AIR SYSTEMS <br />BATHTUBLAVATORY <br />PSHOWERTERSKITCHEN <br />(WASH BASIN) <br />DRYERSOODDISHWASHER <br />SINK 6 DISP <br />EATERLAUNDRY <br />TRAY <br />OVECLOTHESWASh'.R <br />REPLACE BYOOD BURNING( <br />URINAL <br />FIREPLACE INSERT (WOOD BURNING) <br />DRINKING FOUNTAIII <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />�— <br />SINK (SERVICE - BAR. ETD) <br />EXHAUST FAN <br />SUB TOTAL S <br />-- <br />SUBTOTAL f <br />PERMIT S <br />PERMIT f <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY. <br />I MIN, w�P•fN <br />M•P�s'r�1eKX 9`X �!-L <br />S Y <br />IFF <br />n•NCIIICr. NLI�r�� <br />SSOOFEES <br />C 0 <br />IIw lU4I <br />IOI AP!• 60 VK•N<r p Ml <br />�— I <br />MAIN. <br />,N ICn,1,M_N!O4 <br />401tl 1M'111IM1 WE OINWIM-C <br />, <br />yr1.NAMf AI <br />l%:LIIrA�'. `iv <br />Mf111VN11U•ll <br />eAw N[4J1 <br />_F 4 <br />•CdINN•I MAN bYP <br />1)IIIIP <br />ra—r e�i.,Tld i,Viun - <br />PF•tnv <br />aNr e,ALIN0511Ku.M4 <br />nllP r. Y4K,At <br />nrinl Erna <br />MANSAPPPUWner <br />CRY OF EVERETT <br />LOCAL SALES <br />-' <br />-F{ <br />I� `N <br />uat JAG/ $ <br />TAX CODE 15 3105 <br />TOTAL <br />