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AP�PLICATI� N FOi; CONSTRUC'. _ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERE�, WA 98201 •(425) 257-8810 <br />❑ pEMOLITIOPJ ❑ COMBINATION ❑ BUILDIIkG .�' MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT A[IDRESS: Io�OD �i/�A /'ee-l'L I/p v <br />G_ , i T' 1 + A.L e l �- c �., ,_�f- yi�i2/J? i 7JJ/ 1 9�?- 9�R/ <br />GF.N�f1ALCONipACTOR Nr11LA0DRE55 C17V . 71P P�10�1E ilAi[IICFNSE� <br />MF.fN�CONTRACTOR �D�RE55 CITY ZIP CIIONB S7ATF. UGENSE � <br />PIIIMBiNGCON1FFf,TOR MPILADDRE55 Gltt ZIP PHONF STA7EUCENSEi <br />OF <br />FOOUGE <br />Pf10PO5CD USE OF B111L�ING <br />�eca� u[scvui��wdoF v�iorenrv <br />lOT �LOCN _ <br />CONSTRIIGTION IOAN LENDER, AD�nE55, TElEPN04E NUMBER <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH OASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />UFIINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE 3 <br />FOR OFFICE USE ONLY: <br />FR�NTSfTpACN RF.AR SF.TBRCK SIDE <br />USE ZONF <br />ME�G��I l IMIfAIION <br />r,or+Sr <br />FEE <br />—� <br />_: <br />� <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />COt�TAs/f�' RSONANpPHONENO � � <br />' ( .J �aUJ 7(/7 —/GL 5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICA� ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINAMGES GOVERNING THiS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TH@ PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PAOPERTY TO PERFORM THE WORK FOR WNICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATe <br />CONTFlACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x,�� � 8=/9-97 <br />51 NATIIRE �A�� <br />CITY BUSME55 LICENSC NO <br />NO. 7YPE OF EOUIPMENT FEE <br />A/C —lVHN�LG UNITS ' <br />FOACED AIR SYSTEMS � <br />HEAT PUMP � <br />UNIT HEATERS ' <br />CLOTHES ORYERS � <br />WATER HEATER <br />WOODSTOVE <br />METALFlFEFLACEi <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />SUBTOTAL S <br />PERMIT S �j � <br />TOTAL FEE $ / 2 -1 : <br />rinr+cuecKNVMflGl-, n I�EF I�ECFIPi NO <br />IOI RREA VACPNI SITE ��c� <br />❑YE$ ❑ NU pIOIDWf. <br />NOOF[1WElLING 512EOFOl�GrtI <br />UNIIS p1.I/u01NG <br />OCGUP�M l0>0 O�SEMENi MFGIeNICPI <br />❑YES ❑ N� -- <br />nFnsor+ <br />nooinoNni. rinN c��r.tK <br />on�En <br />apasnv <br />$TA1E0411U�NG imu�ni <br />rtnnsnr �qvEoor CITY OF EVERETT rumir.waiKs <br />�/I�� LOCAL SALES <br />neto n � � i'1 TAX CODE IS 3105 TOTAL <br />'G <br />