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APPLICATIr�I �OR CONSTRIDCF �N P��3B��14� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVEA[TT, WA 98201 • 259•8810 <br />❑ OEMOLITION ❑ COMBINATION ,P�J BUILDING IYI, JNECHANICAL � PLUMBING ❑ SIGN <br />PROJECT ADDRESS: '1 - (�, � '� � _ <br />. <br />�:'�; ei�� �i-� v. L� �, L <br />W?�T 4,n� TlJC. 19�o a.iA, EJtt.71 (..a i��✓� Z]�-�SGi� <br />ONMEN M�R�ODf1E55 C�fY lil' 1'NONE <br />TEN�NT YNIADOR[55 f.IIY l�P FIIONE <br />ARGNITCCT0f10E5�GME11 MI1IlnDD11E55 LrtY )n` P��ONE <br />GENEIU�LCO�MMCTOtI MMI�UDf1E55 C�IY Ji� ���ONE Sf�iCIICENSE� <br />FL�C� i�-�'o�✓t/ ('.,,us i zsw ��� no�,a� Lk sr.,•.,� 48tsb .9�•ioC-v7 S.�D 6� o�7S�u <br />MECN�HILALCON7R�CTON MAIIAWRE55 f.ltt T�P PIIONE SfATELICENSE� <br />PlU48WGC04fRACTOi1 MAILADORESS CIfY jIP PIIOHB STAIEUCENSE� <br />.�3i�y <br />DESCt11BE WORNANO SO:JARE FOpTAfiE INVOIVED <br />iDv 3C� <br />SF2 <br />r+a raorERn �u�ovm <br />LOT ,� B�OCK <br />CONSfROCllp/ LOu1 LENDEP. AOpiE55. TElEP1WNE NUMBEii <br />WATER CLOSET <br />BATHTUB <br />SHOWER <br />KITCHEN S�NK 8 DISP <br />CLOTHES WASHER - <br />URINAL <br />DFiINKING POUNTAIN <br />FLOOR DFAIN <br />BACKFLOW PFlEVENTEFiS <br />FOR OFFICE USE ONLY: <br />LqONT5ET0�C1� RCAfISETB�GK <br />Z� 7 0 � <br />USE iONE — <br />r� , <br />I/E�OIIT IIMIT�T10N <br />Z <br />REO'D <br />SUB TOTAL S <br />PERMIT S <br />70TAlFEE f <br />101ABE� <br />�� <br />NO Of OWELLING <br />UNIIC <br />1 <br />OCCUPANTLO�D <br />IIFASON <br />nEe50M <br />�LANS��PnOVED <br />oete 12�i9 �' <br />sioe sero�ex <br />�.�.�S��E <br />/7YE5 ❑ NO <br />SIlE Oi BLOOR I <br />❑YES L�J'NO <br />HEATING SYSTEM: �.GAS ❑ ELECTRIC ❑ <br />f.ONiALi 1`C1150N AND PIIONE HO <br />'R �, ,1 '7 e_. .. � 2 S 2• 2:.; ao <br />I I1ERE�Y CERTIFY TNAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORR[CT ALL <br />PROVIS�ONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE SiATE <br />COIJTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �-�t,l' ,L I ,/I,a'+-,_� ��' / O - �j'� <br />SiGH�TUfIE D�i[ <br />CITV BUSMESS IICENSC NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVERS � <br />RANGEHOOD <br />WATER HFATER <br />MEfAL FIREPLACE <br />FINEPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN b <br />rinH e��ecK r+uunrn <br />c) <br />IIUIIOWf. <br />PIULpWG — <br />IAECII�NIC�I <br />Af)DI IIONAI. PUN C11f CN <br />on¢n <br />$T11E OUII(lINO 511liC11af10E <br />CITY OF EVERETT runnr, wones <br />LOCALSALES <br />TAX CODE IS 3105 7oinL <br />SI�B TOTAL f <br />PERMIT S <br />TOTALFEE E <br />rcF �rr.e�nrr�o <br />�/� 3.l `� <br />FEE <br />