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�APALICATIO�N �OR CONSTRUCTI.�I� PERMIYr <br />CITY UF EVERETT • BUILDING DIVISION G�� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 � <br />fl DEMOLITION f I COMBINATION � I BUII.DING I 1 MECHANICAL � 1 PLUMBING f 1 SIGN <br />ownen Mui <br />� •� <br />IEN�NI raei��uoness r.nv em puOr�E <br />ARCHRECiOP0E51GNCF M�ItADDPE55 CiIY 71P PIIONF <br />II <br />GENERAICOHiMCTdI M�IL�ODRE55 C�Iv liP P�IONE SULEIICGNSE� <br />MECHANILRLCONiRACTOfi M�IlA0�RE55 GTV L� PIIONE STATEUCF.NSE� <br />PLUMBINGCONTRACTOR MAILAODRE55 GfY ZIP PIIONE ST�'ELICFNSE� <br />LONTRACL PRICE OF WOOK <br />HEATING SYSTEM: f�i' ,(�AS f I ELECTRIC I l <br />DESCRIBE VJOi1K AND SIXURE IOOT�CE I4VOlVEO CONT��T CFRSON RN NE NO <br />�r1GCF. FAw� ��e�.s , �I I /i�+ �or« �i/7 j' SG��-GJ/S <br />�a 3 <br />BUILDINQ <br />� 5,� .,ss <br />LOT� BLOCK �_ <br />CONSTRUCTION LOAN lENOER. �ODilE55. 7FLE�IONE NUMPER <br />PLUMBIN6 <br />NO. TVPE OF FlXTURE OR I7EM <br />� WATER CLOSET ITOILET) <br />LAVATORV(WASH BA: <br />SHOWER <br />KITCHEN SINK d DISP <br />CLOTHES WASHER <br />URINAL <br />DHINKING FOUNTAIN <br />SINK (SEFVICE — BAR, <br />I HEREBY CERTIFY THAT I HA\'E READ AND E%AMINED THI; <br />- APPLICATION AND KNON; THE SAME TO BE TRUE- AND CORRECT ALL <br />PROVISIONg OF LAWS AND ORDINANCES GOVERNING THIS'fV�E OF <br />WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN Ofi <br />TWOCOPIES� NOT. THE GRANTING OF A PEFiM1T DOES NOT PRESUTAE TU GIVE <br />AUTHORITY 10 v10LATE OR CANCEL THE PFOVISION OF ANY <br />OTHER STATE OR �. JCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTP ' �ION. THAT I AM AUTHORI2E0 BY THE <br />OWNER OF THIS PROPERI T PERFORM 7HE WORK FOR WHICH <br />APPLICATION IS M E A�.� 1 COMPLY WITH THE STATE <br />CONTRACTOR 7 RCW AND 296200 WAC. <br />— — x �i' �' �I S <br />si��inE onrE <br />CIiY NU:+INF.SS LICENSE NO <br />FEE <br />SUB TOTAL $ <br />FERMIT S <br />FOR OFFICE USE ONLY: <br />PPONTFFTflALK f1EAR5F.TP�CK <br />� 0 2a <br />USEZONE/) IGTARE� / <br />�� % C <br />MEIGII7UMITATIONJ� h� <br />2� uNirs ' <br />OCCUPANCY NO OfS�OFIES OCGUPANfL0�0 <br />RRE00 RlASON <br />� <br />trre <br />SIDE CCTR1��n <br />i <br />V�r�Ni SIIE <br />A/C — AIHNDLO UNfTS — H.P. <br />FORCEDAIRSYSTEMS—D.T.U. M E.A. <br />"..l-1A11 <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE (WOOD BURNING) i <br />FIREPLACE INSERT (WOOD BURNING) ; <br />GAS FIREPLACE � <br />GAS RAtJGE � <br />� <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTALFEE 5 <br />PlANC11EC/x NUMOffI fEF AECFIPINO <br />�'Y ���//J� d � <br />I S I: NO p1111f.iNG <br />�P�S�rt� Lww <br />S � GAQAG`,�t rwMmrv ,_ <br />45EMENt � MFGI�NICRI. <br />IlYGS IYNO <br />— RDOIPpNAI f9�NCRff.N <br />UUM1P <br />srme nunowr sunr,�unrc <br />CITYOFEVERETT rumir,wonKa <br />LOGAL SALES — <br />TAX CODE IS 3105 TOTaI <br />^� <br />s <br />�J <br />