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APPLICAT: `�N F4R CONSTRUC"�'ION IPERMIT <br />CITY OF EVERETT • BUILDING �IVISION <br />' 3200 GEDAR STFiEET • EVERETT, WA 98201 • 259•8610 <br />UEMaUYION p COMBINATION ❑I eUI�DING O MECHANICAL C] PLUMBING O SIGN <br />�,IOJECTACORESS:�S F'jr �iC.lIUAV A-U� /� <br />W��OT . y3/ i�I�SGl�I 1-�JES , /� 9�/G�-3;,�5,���67(o ij `> 7/�j <br />� � i:il MMLAOOPE59 CIfY LI � p�E •- � ..._._.._'_'.._._ ... <br />1�,�, S��vrC�s .%N� Qi7.�X�7� ,c,%'r7dA%_.py��3 3Go_�5 ��F3z _ <br />h.Vl� MNLAU�PES$ CITY jIP p110NE <br />11M1T[CTQIIOEfIGNEN AWLAODRFSS �_ �C�ry IIP PIIONE <br />�f.�LCONIMLTIXI MAILAOORFSS �� ��1:1�Y � SIP PIIONE SUTGUC[NSE� <br />i�,NANICACONiMOTOP ,W�I�ODAESS � LIIY Vr�� ZIP PIIONE STATFUCENSFI <br />� i.;�1WOfANfR�CI011 M�ILAUORF39 f.IfY Slp GIIONE SiAtEUC[NSE� <br />x it,9ACT OWC4 0F WORK � ••.._, �. _. . <br />; �;;tIBE YlORK IWb SOUME f00TA0F INvoWEo <br />. M J � <br />r: �Usao use or euaara <br />•.;A�.OESGUPTION OF PROPERTY.(SHOWN BfLOW 0 <br />i „ C BLOC1: OF <br />o��� /'t' /'I ��--�� <br />� r,"c� r�x �,o, yu�A <br />17Z9oS- z-�5'- <br />11 �o IRUC,TION LWN LfNO[R. ADpRET6, TF,IEPMON! <br />�.ui�eiHo <br />�IG. TVp! OF FIXTURi OR ITI <br />,. WATERCt,09ETlTOILET) <br />BATHTl19 <br />LAVATORYIWASM BASINI <br />OHINNIN4 FOUNTAIN <br />FLOOR DRAIN <br />4i`rl OFPICE USE <br />s rri uTa�uc <br />_ F �ONE <br />n;trt UMR�nON <br />.�;U'ANCY X00f7I0Pof7 <br />qU► <br />. i fi?PIMI(LEHRHQ'0 <br />t �.AIIM fiEO'0 <br />� I'+:!uCONS� <br />— onn, c � �.�� <br />'— �.. <br />� <br />� <br />� <br />_,_, �. <br />� _'�' <br />� <br />SUB TOTAL S -�_ <br />PERMIT S � � <br />TOTALFEE f � <br />NI Y: <br />REAR SEIBALK SIOE 6FTBACN <br />lOiANEA VAC�NfSI1F,.»,..... ..• <br />❑YFS U NO <br />UNi g oWFLIIN(i SISEOFBLbOrtI <br />OCCUPANTl0�0 sA3FMENT'�� � <br />❑VES C) NO <br />CITY OF EVEflETT <br />IOCAI SALES <br />TAX CODE Is �Io5 <br />� <br />HEATING SYSTEM: L7 GAS L7 �L8C7RIC ❑ <br />CONIACT OE090N ANo vHONE N0. <br />I HERE�Y CEFTIFY THAT I HAVE READ AND E)(AMINEO THI5 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CURRECT n�L <br />?°OVISIONS OF LAWS AND OR�INANCES GOVflHNING TIIIS TYPB OF <br />WOR�( WIIL 9E COMPlIEO WITH WHETHER SPECIFIEO MEREIN OR <br />NOT, fHE GRANTINA OF A PERMiT DOES NOT PRE5UlAE 7O 61VE <br />AUTHUqI7Y TO VIO�qTE OR CnNCE�. THE PqO�'ISIUN OF ANY <br />OTHER S?ATE OR LOCAL LAW REGULATING CONSTtiUC110N OH THE <br />?ERFORM��NCE OF CONSYRUCTION. 7HAT I AM AUiMOf11ZED BY ThiE <br />OWN�A JF THIS PHOPEHTY TO PERFORM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH 1'hiE STATE <br />CONTRACTORS LAW 18.2� A�Yl��O 200.100 WAC. <br />CIfY BUSINE99lIL'ENSf. N0. <br />NEAT <br />STOV@ <br />RANGE <br />Vl/�u CIiECN <br />9U�10�N(1 <br />PLUAIOIMI <br />MECMANIC�L ^�•^� <br />AODI IIONeI PINV CIICCN <br />OillEq <br />STA1E OOILOINq SIII1LIUfICE <br />PII01If. WpRKA –'^� <br />TOTAL <br />fEF <br />SUOTOTAL S <br />FEE <br />_"_ � <br />�...._...._ """'"._....._-'.__... <br />_.._.... ......_.._. ..�_L.. _. <br />Z0'd 06Lq WdSO:Z 9665 'ii d3S 9GZGSECOf�Z:01 ld� !7Q�9 11=J?^� d0 1,117:1;0iJ� <br />