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APPLICATI� FOR CONSTRUCT�N PERMIT I <br />CITY OF EVERETT • BUILDING DIVISION Si - �4- °�:� � <br />3200 CEDAR STFEET • EVERETL WA 98201 • �425) 257-8810 p J:, c; - Z <br />❑ DEMOLITIDN ❑ COMBINAT ON ?�^ BUILDINC ❑ MEC�N/p NICA ❑ PLUMBING ❑ SIGN <br />PROJECTADDAESS:_���j'�'�/3Z lJ�.(1,ST� <br />�.n <br />MfC1�lNiC�ICnN111�C1U�� �I��l��%H1f55 <br />1'111MpmGCDu1N�r,�ryi N��4IiME55 � <br />I;ONIf11LI 1'111L[ Of Wq1F <br />�.6�58.�_ mo E <br />or;rnmr wonx �r���;own� rr�oucr n�Jonm <br />� o�nsrovra oi nmia�,vr � <br />-�u�'c�_F3ttl� �CEkc_s.T.,_� <br />imu o�snmmor� o� nnorum �s�owu eaow a� 1�+•a� <br />io� _ aior.. _�� or_�Ll�I <br />>L��_Dn%ift�l� ` r�.t94 :� <br />"��'_`-' 7 L �� ��H��i <br />rnncn �r m r i�in <br />_4S_42-0o1—P_�o -momA� <br />covs�mwnon mu� � ror.rn..�ni�as. iucn�ouc r�uvnen <br />PLUMBING <br />NO. TYPE OF FIXTUPE OP ITEM <br />WATER GLOSET (TOILET) <br />BpIHTUp <br />LAVA70RY IWASH OASIN) <br />FOR OFFICE USE ONLY: <br />innN�Snn�rrc nr� <br />nsl I<Til'—_ OI u� <br />—/` ]1//�1 i <br />���If.l�l 1�411A1 UY \ �i 1� <br />�i��lj�'.��i1l.xlll�lll�]U ��IA�(IH <br />.�/l�________ �� � <br />11.1>II�I�\!IIlU�[r I�II-R�<,n�V�� � <br />�� ._ ���'� ' <br />iw� rn rn��v — ri.m..u•rnovrn <br />�-N �rc-�s <br />�.�__�lLi finn\ H/u <br />ri� ���oN� C2mG)GZS—(l04 <br />w.� �6,.-tF�m.-$Cr.�ut� .ur R_44l�- <br />IiCCNSF � <br />: I�CEMS[ • <br />C IICOSF • <br />GAS i] ELECTRIC ❑ <br />�j <br />I HEflEl1V CERlIFY 1NAT I H�VE REAO AND E%AMINEO THIS <br />GPPLICATION AND NNOW TIIE SAME TO OE TRUE AND CORPEGT ALL <br />FPOVISIONS OF �AWS AND OROINANCES GOVEflNING THIS TYPE OF <br />1'lORN WII� �E GOIAPLIED WITH WHETHER SPEGFIEO NEHEIN OR <br />�:07. THE G�AN:ING OF q pERIdiT �OLS N07 PR[SUME TO GIVE <br />AUTNOf11iV i0 VIOIATE OR CANCEL TME PflOVIS�ON OF ANY <br />OTH[R StqTE OR IOCAI l�W PEGU�ATIIIG CONSTPUCTION OR THE <br />PERFOiiI/ANGE OP CONSTRUCTION TlIAT I AM AUTIIORI2E0 �V THE <br />OWNEq VF THIS PPUPERTV TO PERFOPM Th1E WOFK FOR WMICM <br />APPLICATION IS IAFDE ANO I COMPLY WITH TME STATE <br />GONTRACTORS lAW IB 2] RGW AN� 296200 WAC <br />X —__ <br />[ c.xn�ura o�n <br />Cli� p115111( SS IICFNSL 110 <br />S <br />5io[SciBecx rt�ucc(�— J J�—+'— <br />v.uvi sm FEES <br />❑r[s ❑uo nv��n�.,r. <br />5R`'E or ot�O1G�i — <br />V�/zC�/�r� �l�IM11iN�� <br />D�SMfN� qfUun¢q <br />❑v[5 �x0 — <br />' ,(L ����y� /Db1iONci PI�NORC[ <br />U'I�IJ l.`I.�i�� _ UI��[11 <br />)O�J �'2� w�mmoo�t.s��naunc� <br />CITYOFEVEHETT ��nnimwoi�.� — / <br />LOCALSALES ------ f- <br />TAX COOE IS 7105 TOTAL <br />L' �f.'V �.rY/f��A /R�'\ <br />SU� TOTAL f � <br />PERMIT S <br />TOTALFEE f � ` <br />94,9� �«<��,,,o <br />LURTION FEE <br />��60 —�— <br />_ _ ._._..____�—.— <br />