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APPLICATIP 11 FOR CONSTRUCT" flN PERMI'� <br />CITY OF EVERETT • BUILDING DIVISION �C+�'� <br />3200 CEDAR STREET • EVERETT, WA 90201 • 259•8310 <br />O DEMOUTION �COMBINATION ❑ BUILDINO ❑(� MECHANICAL G PLlIM81N(3 ❑ SIGN <br />PROJECTAD�RESS %/I�� ��Sni���Cn�ri_ Kdlc�. <br />TENIJIT <br />f.I1V 7�P 1`nONC <br />a9o�l�s� <br />•11LIII1CL70ROESM.NER MM�DORESS f.1IV 7i� PNONF <br />�� .Sv.irc..Cc�S�� �C. -----5 H_IME� -- <br />OENEMlLd/IMGfOR M1Vl�p0{iE64 fAlv J�� PII(N1f FIAI[IICENSE/ <br />MECNAMCALLONTRACTOR Y�JI�[q1�E55 1:I1� 7i� �110NE lST�fEIICENSE� <br />PLNlNOCONIRACTdI M4L1100(IE54 CIIY 21P 1+IqNE ST�TEIIGEN5E1 <br />'�AS��- � �.11i5 v <br />M10P07EDUSEOi �� L` _'_ <br />lEONO[SCWYf10N O�P110PERTY Ig�D�M�lFIOW IXI�Iff �11 TNO COA[51 <br />iot � eiadt a <br />Sl��l�+�- � ►�oa-��- 9�0 <br />�v�Cc�d.�d Hnde�- `�b�D3D5oJa _ <br />iwctt rui i o. rw,�[n <br />CON9IRlICl10N ldW lEMOER. Mp1E54. TElEP110NE M1�NEP <br />K�� <br />N0. TYrE OF FlXTUIIE OII ITEY FEE <br />_ —� <br />WATER CLOSET (TO�LET) � <br />BATHTUB S � wRl' fA --i— <br />LAVATOHY pN118H BASIN) � <br />BHOWER ' <br />KRCHEN SINK 6 DISP � <br />FOR OFFICE USE ONLY: <br />i11dA:#TRACK�� REMSET N <br />4fi <br />USE IONE O r/ I01 M1E� <br />�� <br />IIEI611f11MT�TH�� Noauwcwr+o <br />INIIIS <br />-N 1 oeie <br />/ SIOE SE7lB�f:H/ <br />J <br />V�G1N1 Sllf <br />❑YF6 ❑ Nt� <br />SIfL Of & Il(ili l <br />NEATINO SVSTEM: GAS f_1 ELECTRIC ❑ <br />r.or�ucr vrnsori urt� riror� <br />_. V�L �'�b� �L 145(.. <br />1 HENEBY CERTIFY THAT I HAVE READ AND EXIIMINEO THIS <br />APPLICATION AND KNOW THE SAME TO BE TRl1E AND CORRECT ALL <br />PROVISIONS OP LAWS AND ORDINANCES OOVERNING THIS TVPE OF <br />WORK W�LL BE COMPLIED W�TH 1riiETNER SPECIFIEO HEREIN OR <br />NOT. THE GRANTINO OF A PERM�7 DOES IiOT PRESUME TO OIVE <br />AUTHOPITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTNER STATE OR LOCAL LAW HEOULATIN(i CONSTRUCTION OR THE <br />PEFlFORMANCE OF CONSTRUCTION. TNAT 1 AM AUTHORIZED BY THE <br />OWNER OF TI11S P�OPEHT/ TO PEpFORM THE WORN FOR WHICH <br />APPLICATION IS MADE AND I f:OMPLV WITH THE STATE <br />CONTRACTORS LAW IB. W AND'198.200 WAC. <br />x ` ) -- ! - % <br />SNiN�IURE 0111E <br />LIfY EULNE6: L�CENSC NO <br />A/C—M/NDLO UNffB <br />FORCED AIR SYSTEMS <br />GAS PIPINQ <br />IXHAUST FF <br />SUB TOTAL f <br />PERMIT f <br />iOTALFEE S <br />� I n�O _ I nrtrmi ra <br />mni nwr. -'Q/. �c�` <br />2 A, Z � PI!IMIIINf. ___"— —" "- — <br />�"' --- <br />♦SEMENI MFCII�NH:�I <br />❑�fF Nq —' <br />--'---- ADpIN1NM 1'I�NCIpCM <br />p11�E1� <br />ST�I E OUII D�N6 SIIO[IIAp6f <br />CITYOFEVEflETT runiw:wrn�KS <br />LOC/1L SALES --- <br />TAX CODE IS J105 TOTAL _ <br />FEE <br />