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APPLICATI� N FOR CONSTRU�'� .ON PERMI'i <br />CITY OF FVERETT • BUILDING DIVISIOU � <br />3200 CEDAR STREET • EVERETT, WA 88201 • 259•8810 <br />❑ DEMOl.IT10N �COMOINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PHO�IECT A�DRESS: ��'��'�,e/5/ ��,�/C,' <br />PP:CE OF WOfIN <br />� <br />lE6�L DESCRIPTiON OF PNOA <br />lOT � BIOCN <br />wvaven <br />CONSTIIUGTION LON/ IENDER. /JXNiEiS. IELENIONE NU40Ef1 <br />TYPE OF FURURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATH*UB <br />SHOWER <br />�-AUNDRYTRAY <br />CLOTHES WASHEP <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PI <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />iRON�LR� PEA115ETBI�LN <br />_� <br />IISE IONE � / lOi �PEA <br />MEIONTIIMITAPON NO Of OWELIING <br />� � VNIfS <br />O:CUPANCY Iq Of SI(%Y6 UC:UP�NI L0�0 <br />n�tE <br />I SIDE SFiB�CN <br />� •--+ / <br />r�wriF <br />- -- _� 066 <br />runNe Slef[ IICENSE � <br />����'+� ST�TE UCENSE � <br />..__'_SY_�da� <br />PIIONE STAIE IICENSE � <br />IiEATING SYSTEM: �` GAS ❑ ELECTRI'� ❑ <br />roN� r ru�sn�� Nb P110NE K: <br />� �L '�ff{r) L S'-/ �i72� <br />I HEREDY CERTIFY THAT I HAVE READ AND E%AM'NF.D THIS <br />APPUCATION qND KNOW THE SAME TO BE TRUE ANO COR�7':CT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOqK WILL OE COMPLIED WITh WHETHER SPECIFIEO HEREIN OFl <br />NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTIIORITY TO VIOLA'(E OR CANCEL THE PROVISION Of ANY <br />OTHER STATE OFl i0C AL LAW REGUUTINO CON�TRUCTION OR THE <br />PERFnRMANCE OF CUNSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOHM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 ACW AND 296.200 WAC. <br />x.1 - _3 �v-97 <br />516N�11/f1E DA1E <br />GIfY 81151NESS IICENSE NO <br />NO. TYPE OF EOUIPMENT FEE <br />*— -- <br />' U A/C—M{NDL6UNRS <br />' � FORCEDAIRSYSTEMS <br />� [] HEAT PUMP <br />ri <br />CLOTHES DRYERS <br />flANGEHOOD <br />WATER FIEATER <br />WOOD STOVE <br />O FIREPLACE INSER? <br />/ GAS FIREPLACE <br />F�N <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />� rrr�O ��rr.cirrNo <br />vecuasnc rcts <br />❑YES ❑ No p11110�N0 <br />SRE OL Bl R 1 �— <br />l27`i �F7v S, F. riuunia _— ----- <br />BASE1.ifNT NECIIeNiC�l <br />L�IYES NO -- - <br />— �UUi110N�IPIAHC�111:M <br />OIIIEO <br />xui� nunoinr sunr.�unrc <br />CITY OF EVERETT runnr. wnn�c <br />LOCAL SALES -- -- — <br />TAX COOE IS 9105 ioin� _ ___ <br />�__!.Sb <br />;ao <br />'c�. � � �, <br />�—_L.--- <br />