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APPLICATI4.! FOR CONSTRUCT�ON <br />CITY pF EVERETT • BUILDING DIVISION <br />� 3200 CEDAR Sl REET • EVERETT, WA 98201 • 259-8810 <br />L� DEMOUTION �❑ COMBINATION �-� I�NG <br />�__1� - ---- '` � '//L �� /�_ �N'�� <br />PROJECT ADDRESS:_ ; Z � <br />PE�MIT <br />� <br />O PLUIIABING ❑ SIGN <br />� � <br />a¢Henu corrtn,.cior� u�n �aon[ss — <br />f�lv /i� P�IONE SI�IEIICENS(• <br />4ELN/J/ICA CplTPAC10q MM( �ppqE55 — <br />LITY 71P PllpyE SIATE LN:EN$[ � <br />PIU�lWCCpl1RA[Tpp 4�R�ppqESS �ItY <br />r�n ���E S1AIE LICEN$( � <br />OESCRIlE YqNM �Np $q�ARE FOpTnpE W VOIVED <br />���\fCi �<\Ct((� <br />l0T BLOCN p� <br />PMCEL TNI10. INMBEH <br />,;�(.�C: n��� �-T� � <br />Cp15TM1CT�ON IOM! LENDER. �Dp1E55. TElEP/10NE MJYlEp <br />�wreiNo <br />NO. TYPE OF Fl7(TUpE Op ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV�WASH BASIN) <br />SHOWER <br />KIiCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />CIOTHES WASHER <br />URINAL <br />ORINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PqEVENTERS <br />SINK (SERVICE — eAR. Frr. � <br />FOR OFFICE USE ONLY. <br />FIIONT SETp�It REIq SFTB�LN <br />USE 20NE <br />NEI0111 UAryGTION <br />0'LCUPAt1CY NJ (If SIMFS <br />io�enre <br />SUBTOTAL S <br />PERMIT s <br />TOTALFEE f <br />SIOE SFTB�CM <br />WC�NI $IIE <br />❑YES ❑ Np <br />� a �«�� ' SIZE Oi BlO0R1 <br />UNIIS <br />�vES ❑ MO <br />HEATING SYSTEM: ❑ GAS CJ ElECTRIC ❑ <br />Cp1GCi �COSp111M0 PIIpNE NO <br />� <br />I HERf BY CERTIFY TNAT I HAVE READ AND E%ArAINED THIS <br />APPLICATION AND KNOW TH[ SAME TO BE TRUE AYO CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT ppES NOT PR:SUME TO 61VE <br />AUiHORI?Y TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />O7HER STATE OR �OCq{, LAW REODUTINp CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THA7 I AM AUTHOHI7ED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WOHN FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TME SiATE <br />CONTRACTOPS LAW IB27 RC ANO 2 200 WqC. t� <br />�' � ������ `� y � D 9� <br />�, � <br />5 TAfUR� � —� <br />• OATE <br />CITY BUSINE55 tICENSC /q <br />N�� I_ _ T'PE UF EOUIPMENT FEE <br />�NC — AMN�I.[i i �uirc <br />WATER <br />M�W C11ECK NUMpfll <br />OIIIIOMfi <br />�1I1M01Nfi <br />MfC11�NIC.e1 <br />•UlNIIONM M �H Cnf Ck <br />Ol ll(P—�—_-- <br />$IqF P1111��Nfi51111C1�M(iE <br />CITY OF EVERETT rupncwrxat <br />LOCAL SALES — <br />TAX CODE tS �105 to7A� <br />SUB TOTAL f <br />PERMIT S <br />TOT" FEE S <br />ffF �11ff.flPr� <br />