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AWPLICATION FOR CONSTRIDCI'ION PERfNIT <br />CITY O� EVERETT • DUILOING DIVISION � <br />3200 CEDAR STREET • EVERE'fT, WA 9U201 • 259•8810 <br />❑ DEMQLITION ❑ COMBINATION fA�B��LDING <br />� � ❑ MECHANICAL O PLUMBING O SIGN <br />PROJECTADDRESS:�9o� �✓�fy ��� �yrPil� <br />r . .. <br />., ...�,• uuieooness - •,•••� .�--•.• wq� YKaol S/327�e 2 <br />cm z'^ � rnor+E �---__ <br />TENANf 1.11111.ApUfIf55 -- � <br />�hh CIIY 71� �� <br />PupNE --- <br />--�'�L9/ 5 M4d 'sm Sr �w{�t .��� 9� � 5�-°s3/ <br />anauicer noESim�En uuunoness � <br />� Cliv <br />7/inm.�}) N/.rn/C ���� �IIONE <br />FlefE LICENSE � <br />� "'�^� SI�iE LICENSE � � � � <br />PLVIIBINC-���pq M�II�UDRE55 <br />CIry Z�� PI�ONE <br />SfAIE LI�ENSE • <br />CONIMCi VNCE OF WOfiK <br />OESCNBE NWiN ANO SOU�f1E fOpUpE u1VOlVEO� <br />�C�.� )' /i,< <br />�' l� (t �-2� ��%� <br />5a5 <br />P�W'OSEOUSEOfBUItDINO � <br />IEGAL'JESCfI TIpNOFPfiOPE11IY�5110WNBElONp1111r7 �— �� —' <br />� COPIE _ <br />l0I �IOCN p� � <br />�MCEL 7AM I,O. NUMOER �� fL��7---�--�-�— <br />CONSfl1UGIICN IO�N LEN�ER. �DDf1E55. IF.LEPIIONE NUMOEiI <br />PLUMBINO <br />NO. TYPE OF FII(TUAE OR ITEM FE <br />Z WATER CLOSET (TOILET) i � <br />BATHiU j <br />Z IAVATORY (WqSH BASIN) �/ <br />SHOWER '— <br />KITCNEN SINK 6 �ISP �'— <br />� DISHWqSHER <br />LAUrlDRY TRAY <br />, CLOTHES WASHER --"— <br />URINAL <br />DRINHING FOUNTAIN <br />FLOOR DRAIN - <br />_ BACKFLOW pREVENTERS <br />SINK (SERVICF _ pnn e.r � <br />FOR OFFICE USE ONLY: <br />iROHiSETB � REAfi5E76�CN <br />USEIONE lOtAnFA <br />NEICHf LIMIf�pON NO Of DWELLINO <br />UHI IS <br />or smmcs <br />— /J <br />� <br />FEE <br />f <br />SIpE SETBACN <br />��=ni �nu �rD 1 EM: <br />f.ONULIPCII-- S�q— �����ONE <br />c'�5 �� r_�r_crRtc ❑ <br />I HEREOY CERTIFY THAT I HAVE READ AND EX/1MINED THIS <br />APPLICATION AND HN01V THE SAME TO BE TPI IE AND CORRECI A�L <br />PROVISIONS OF LAW$ AND ORDINANCES GOVEpNING THIS TYPE OF <br />WORK WILI DE COMPLIED WITH WHETHER SPECIFIEU HEREIN Oli <br />NOT. THE �RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTIiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTFIER STP.TE OR LOCAL LAW RE6ULATING CONSTRUCTION OH THE <br />PEFlFORMANCE OF CONSTqUCTION. THAT I AM AUTHCRIZED BY TfIE <br />OWNEq OP THIS PROPERTY TO PERFORM THE WORH FOFl WHICH <br />APPLICATION IS MAOE AND I COMPLY Y�ITH THF S�ATL" <br />CONTRACT AW 18.27 RCW AND 296.200 WAC. <br />x //'�[0-9l0 <br />siaNn <br />O�fE <br />CIIY OUSINESS L10EN5[ N0. — <br />IECHANICAL — <br />NC — NFINDLG UNITS <br />FOIICED AIFl SYS7EMS <br />UNIT <br />PUN CIIECN Npl,lflfll <br />�^� <br />v�C�Nt511E � <br />❑YES O NO <br />IIWL�INO <br />S�IE OF O100R I <br />STOVE <br />�4f30 SF riuum'm <br />pASEMENf <br />MEC�I�rvlf.�l <br />OYES (9r/T <br />�— �UUIIIONQPIANG�II,Gk <br />OIUEO <br />S1�1E OWl0�N65UfiL11AlICE <br />CITY OF EVEqETT rumir.wpne5 <br />LOCALSALES <br />TAX CODE IS 7105 707A1 <br />TOTAL f <br />A1T S <br />IFEE f <br />�EF � I nFf.F.IPI NO <br />• ✓ � <br />