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APPLICATI�1 FOR CONSTRUC7""�M PERIIAIT <br />CITY OF EVERETT • BUILDING DIVISION <br />320D CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />[1 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBiNG ❑ SIGN <br />PHO�JE�C7.Ts- AUDRESS: �� iL t.• ��. S_ <br />�_. r1'. /. , i,/ n... L. itt �uio� li,., CIS'?/i i L;�/J_ /.�:7. <br />n/�i4- it//il-_ <br />C{IIY (iv s� P��ONE <br />�rcf..y�.y�uti' !".�G7.�[.l: l%n. % <br />ARLMtCCT(Ni0E51GNER,F� MMl(J10RE55 G GItY 7��• PNONF <br />� �R7f'L! Cf',Q (Jll'7ZPii/ _' <br />OfNf.MICONiMC10f1 Mu�ApDR[i5 CtlV 7i� f'•IONE SI/1TElICENSE� <br />MECN�NICAICONTRA�7011 IUII�DDnE55 CIfY lil` �rl(WE STetEL�CENSE� <br />PWWN6CONfR�LfOR MMI�WDRE55 Clfv IIP PHONE STATELICENSE� <br />�oi <br />/ <br />VN711M <br />— /2 5l �', <br />c7ti^'ti[ p�b��i'u��� /7S'/L7 J <br />PLUYBINO <br />NO. TYPE OF flXTURE OR ITEM FEE <br />Z WATER CLOSET (TOILEn ! <br />"L BATHTUB ; <br />Z, LAVATORY(WASH BASIN) � <br />SHOWER ' <br />KITCHEN SINK 6 DISP � <br />—� <br />DISHWASHER � <br />UUNDRY TRAY ; <br />( CLOTHES WASHER � <br />URINAL __1 <br />GRINKING FOUNTAIN � <br />FLOOR DRAIN � <br />_a <br />BACNFIOW PREVENTERS ; <br />.�- SINK (SERVICE - BAR, ETC.) <br />- - <br />_ <br />— _ _1 <br />i <br />SUB 1 OTAL f � <br />PERIiIT f � <br />TOTALFEE S ! <br />FOR OFFICE USE ONLY: <br />iRONT 5ETB11CN RE�R SETB�CM <br />USEId1E �l i IOfME• <br />�� � <br />NEIGIIT IIMIT�T10N , NO Of OWEllIN6 <br />� UHIIG I <br />pC{;UP�NGv NO d S�(�f' CGCUPANf IO�D <br />SIDE SEIB�Lk <br />5� <br />V�C�NI S��F <br />❑v(5 PINO <br />HEATING SVSTEM: � GAS ❑ ELECTRIC ❑ <br />caN�r�c,yvcnsorv�N No � <br />_ Yt� -x.t�, , �S�% - ���<<- <br />I HEREOY CERTIFY THAT I I1AVE READ AND E%AMINED THIS <br />APPLICATION ANO KNOW THE SAME TO BE TqUE AND CORRECT ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNF ORANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br />AUTHOhITY TO VIOLATE OR !;ANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW Fle6UUTIN6 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. TI1AT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT RS LAW I8. RCW AND 296.200 WAC. <br />x � -���-�-v iz z3 -y�: <br />51GNAfUREn' JAIC <br />A✓crl1.Q <br />GITV BUSINESS I�CENSC NO <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />em. _ eiuurn � i iurrc <br />� <br />HEAT PUMP <br />UhIT HEnTEFiS <br />WATER HEATE <br />WOOD STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />� <br />SUB TOTAL f � <br />PERMIT f � <br />TOTAL FEE S /)/, ! � <br />PlANC1iECKNUMO(ti � f� �,^ _,� � �Ff.FIPTNO <br />OWI�Mf. <br />SItE Of 91U6/� I <br />I�?�C� P111411W0 — <br />J <br />BASEMENf � / Mff.I11NIG1 <br />❑YfS �0 –"'-- <br />•DO�IIpNq.1`l AN U�f GY <br />onrtn <br />SIAIE 0114[nNG SunOun6E <br />�� CITY OF EVERETT runnr. wonKs <br />LOCAL SALES <br />TAX CODE IS 9105 70TAL <br />