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APPLICATI� N FOR CONSTRUC' .AN PERMIT <br />CITV OF [VERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 9B?01 • 259•Bfl10 <br />La Dt1ylOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL [] pLUMBING ❑ SI(iN <br />PROJECT ADDRESS:i 830 Broadwav �verett, WA 48201 <br />TEN�NT MMI �OD0055 f.11Y 711' PIIONk <br />�IiLINTCCT 00 �ESIGNCH Alell �OOOE55 LIIY ni� -'�----�---" ruoe�r <br />Or��er <br />GENEfI�I WNIO�Cidl MAII ��I1fiE55 ---- GIIY —'�---- !IP _"---- �— � I'u01�L SGIE IICCNSE � <br />AIECNANIC�I CONTR�CIOR N�IL ADORESS f.liY 11P PI1011C Si�TE IICENSE • <br />PUIYflWGCONIRACTO{1 M�IIADDRE55 CIIY IIP 1'lIONE STAIEIICENSE� <br />L0117fl�CT PRICE OF WDOK " — <br />NEATING SYSTEM: ❑ GAS ❑ ELECTRIC C] <br />DESCWBE WWINANOSOU�PEiIX)T�fiE WVOLVEO CONUCI PfR5011�NDI'110NENO <br />�1��rk Stewart 388-951.3 <br />lE WL OESCAIPTION OF PROPE <br />lOi BIOCN <br />PMCEI iA% 1 D. M1MBEp <br />LONSiHlIG710N l O�N t ENt1ER, �qIRE55. fEl EI'110NE NUMBEf1 <br />NO. TYPE OF FIK <br />WATER CLOSET (TOII <br />BATHTUB <br />LAVATOHY(WASH BA <br />SHOWER <br />NIiCHEN SINK 8 DISI <br />DISHWASHEH <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKIN.i FOUNTAIN <br />FLOOR DRAIN <br />I IIEHEDY CERTIFY TfiAT I 1{qVE flEAD AND EXAMINEO Tf115 <br />APPt.ICATION AND KNOW T1iE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A� ERMIT DOES NOi PRESUME TO GIVE <br />AUTFiOPITV TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR 40CAL LAW REGULATING CONSTRUCTION OR THE <br />PERFURRIANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO 8Y THE <br />OWNER OF TliIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B. NLL296200 WAC. <br />x��i C . , .<<�'-�'�t' U� 5/16/97 <br />SIONIITUOE p��� — <br />CIIY tl11GMFS5lICCNSC NO <br />IAECHANICAL <br />OR ITEM PEE NO. TYPE OF EOUIPMENT <br />' /VC—MiNDLOUNRS <br />; FORCEDAIRSYSTEMS <br />�— HEAT PUMP <br />' UNIT HEATERS <br />i CLOTHESDRYERS <br />—�— — -- <br />! RANGEHOOD <br />SUB TOTAL f <br />PERMIT S <br />I TOTALFEE f � <br />FOR OFFICE USE ONLY: <br />fRONTSETP�f.K PE�OSFIBACN $IOESE7B�CN <br />USEIONE iotenee vecun sue <br />❑rE5 ❑ No <br />uemm uwunoN �a a uwnuew size or uuxm <br />lINi15 <br />Iq M <br />❑YES ❑HO <br />MFfAL <br />GASRANGE <br />GAS PIPING <br />[%IfAtIST FAN <br />P� �N f.11Cf.N NIIMpfO <br />nuimwr. <br />('1111A111N1i <br />MECI1�NIf.M <br />�pp1110NM PI AN Ci I! Gk <br />011�[11 <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />rrr- ner.cmi Ho <br />til�ll' IIIIIIIn111i ti1�11L11�11L1 <br />____._.___'_____ _____ __..—.__' <br />orr.oe�sr mnr�sevrnovenor CITYOFEVERETT i��mrn:wnnn�; <br />LOCALSALES - -��� <br />u.n TAX CODE IS �105 TOTAL <br />FEE <br />_ ... _ ..-- �--- <br />-_ - - --.. . -'-- - <br />