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APPLICATi��i FOR CONSTRUC7 sON PERMIlT <br />CITY OF EVERETT • BUILDING DIVISION CCA���� <br />3200 CEDAR STRE[T • EVERETT, WA 98201 • 259•8810 �rr <br />fl DEMOLITION fl COMBINATION I-1 BUILDlYG fl MECHANICAL i I PLUMEtING f 1 SIGN <br />PROJECT ADDRESS <br />6 — �� �� 1_ A c.� t� -�'�� r e_rl°c c,�� A <br />,��i-. i�.�..F� � it� E'�.c�'Cr�Fr� e' G�Q. f,}��I�J-SNc�NoM�S N'7`S��l/ - 5 65'-6.�/S <br />IEN�NT MRIIRDOPF.SS CI1Y )iP PIIONE <br />�RGInTCL70R DF.SIGNER M�II �nORE55 CITv )IP PIIONF <br />GENERhLCONIR�CIOfi M�II��ORESS CItY )iP P�IONG SIA1ClICCNSf• <br />MECH�NICAICOViR4CTOR MAIL�DDRESS CITv )IP PIIONF. STRiFUCFNSE• <br />PLUMBINGCONiR�CTW1 N�IIADURESS CIfY IIP P110NE STAIELICENSE• <br />_ ...............�.... ...,,.� �L/ �'J� <br />OESCPIBE W0� N �NO SOII�RE FOOiAGE INVOLVED <br />5„�(,�,c �Aw. �f5 iS �� <br />A�/� //D� <br />PROPOSkU USE OF Bl11lDINa <br />SA �,. e <br />IEGALDESGRIPiI'XIOFMIUPERTY(SNON'NB OWqi�TT�CNTW000olE5� <br />�or � e�ocK �I? I�-9�� <br />� 9�8- ood -na� - //a � <br />PMCEL TA%10. NUTABER <br />CONSfRUCiIONLO�NLENOEN.�O0RE55.TELEPHONE NUMBEH <br />NO. TYPE OF Fll(TURE <br />WATEF CLOSET (TOILEn <br />,r2 BATHTUB / <br />3 LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />/ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRE� JTERS <br />SINK fSEHVICE — AAR FT <br />F'OR OFFICE USE ONLY: <br />fRINiSFTPACN fiF.�fISFT <br />� 2 <br />USE:OYE _ � iorenen <br />NEIGIII LIMIT�TIO � NO OF ON <br />qQ IINIfS <br />�u <br />OCCUP�IICV Iq C� SIOfJ[5 OCCUPAN' <br />GIlOUP <br />•3 u-/ 2 <br />FlREALAR RE00 f1F�50N <br />�� <br />ainesar�IryKiEnneon nFnsory <br />/�( J <br />rvvFo�r.oNsr rinNs�rr <br />� � I)AtE <br />��. <br />FEE <br />SUB TOTAL 8 <br />PERMIT S <br />TOTALFEE E <br />SIDE <br />HEATING SYSTEM: I`i A �l ELECTRIC f"1 <br />NO <br />� /TY -S6b'-6,�is— <br />'�IEREBV CERTIFY THAT I HAVE READ AND EXAMINE� THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T'/PE OF <br />WORK WILL BE COMFLIED WITH WHETHEP SPECIFIED HFREIN Ofi <br />NOT. THE GRANTING OF A PERMIT DOES .JOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVIS!ON OF ANY <br />OTHER S7ATE OR LOCAL LAW RE.;UL{`TINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AIITHORIZED BV THE <br />OWNER OF THIS PROPEPTY TO PERFORM THE WOFK FOR WHICH <br />APPLICATION IS MAD AIJO I COMPLY WITH THE STATE <br />CON7RACT LAW RCW AND 296.200 WAC. <br />X �j_ �"SS` <br />SIC �TURE OAIE <br />CITY BU i1NE55 LICENSC NO <br />— n.r. <br />— B.T.U. M E.A. <br />l�N1T HEATERS — B.T.U. M <br />C�_OTHES DRYERS <br />Vl'NTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />EXHAUSTFAN <br />Pl AN CI�Ef.I( <br />vecev� sirE FEES <br />O /✓�FS f 1 NO <br />_ flUIIpMG p Q . p <br />SREO�AL[Kirtl � —�'� <br />�4 z SF L�v�./4 } p�pMIIM6 <br />�i SF Caaaao� . <br />BRSEMENi � MFGIm�ICFI <br />'� fIYES IW;O <br />ApfL110NM. M AN G�[f,K <br />ai��en <br />srm� ounon+r sunciuncr <br />°v CITY OF EVERETT ��inur,�voras <br />LOCAL SALES <br />/c,� TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />v�y1L � � <br />fE[ �iPf.l'IP: NO <br />,c// 7 %� <br />FEE <br />