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APPLICATI(..J FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVEHETT, WA 98201 • 259•88i 0 <br />❑ DEMOLITION �( COMBINATION ❑ BUILDING ❑ MECHANICAL <br />PROJECT ADDRESS: '"�"� =� `� ��-A•'� �=�' �=- <br />❑ PLUMBING ❑ SI(iN <br />-- _------ .p ?.� <br />o, t}��17c�S� '�D�-/o�u�fJ '90�� m�o�+F 77�'—o�KYg • <br />�RGMiC ORDESIGNER MI111�DDRE55 ��Y <br />GENERILLCONTR�GTIX1 MuI�OlPE55 � �� CITY Zi� ri�ONt sl�rttiC[r+sr• <br />� <br />MECNMlICALCONTR�CTOR MAILA�C.RE55 f.itt IiP VIIONE St�TELICENSE• <br />PLUMBMMsCONTRAGIOR M�ILAppqE55 CItY diP PIIONE $1ALElICENSE� <br />DESCIMlE YqRI(11N0 SOU�RE FOOT/�GE <br />n <br />C�HKHCi�C : � �7 / J'l�, �7 • <br />o usE pov eui ra <br />/C �� ��/1%%% `% i. <br />IEMI DE'LRIPTION OF PROPERTY I�pWM BEIOW OR ATT/�LM TVO COPIE51 <br />�oi eioac oF <br />�SEE �G�NS • <br />�Tya'7v y - S�- OoZO -OOO / <br />C(W5T11ULTION 1 OIN lEN0ER,1q1WNE55. TElEP110NE NUMBER <br />�// J <br />PLUAIl1l16 <br />NO TYPE OF FlXTUNE OR ITEM FEE <br />WATER CLOSET (TOILEn <br />/ BATHTUB <br />�- LAVATORY (WASH BASIN) <br />SHOWER <br />) KITCHEN SINK 8 DISP <br />DISHWASHER <br />I.AUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL f ; <br />PERMI7 f � <br />TOTAL FEE f J <br />FOR OFFICE USE ONLY: <br />FI10NT SETBAGI( RE�A �TBALK SIUE SETB�C1c� <br />� S ZS -7. 5 <br />USE 20NE D Cl IOI �R�EA/ WCANf C <br />/l� �✓ I / S�O YES ❑ NO <br />��Nr u�unow , r+o a owEiuwc <br />2 UNIfG / <br />OGGUPANCv Iq d SIpbFS 0(:CUP�Ni IO�D <br />uaaM Aeo•o <br />o�iE <br />LI <br />❑V[5 IWNO <br />HEATING SYSTEM: ifCl GAS ❑ ELECTRIC ❑ <br />A <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS qb <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHC�'TY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER ....�TE OR LOCAL LAW RE(iULATING CONSTRUCTION OR TME <br />PERfORMANL'E OF CONSTRUCTIO�. THAT I AM AUTHORIZED BV THE <br />JWNER OF TNIS PFlOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 F,.^.W hND 296.200 WAC. <br />X � _ � ��u.��- � S-S6 . <br />SIG T E D�TE <br />Cltt BUSINESS ll�[NSE NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />rvv —rvni��w vn <br />FO(iCED AIR SYSTI <br />HEAT PUMP <br />UNIT HEATERS <br />CI.OTHES DRYERS <br />RANGEHOOD <br />WFTER HEAT[R <br />MEIAL FIREPIAGE � <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />SUBTOiAL S <br />PERMIT E <br />(c99.�� <br />PUNCIIECK NUMAPR`/ �GPn �r �FCFIPi NO <br />� �� 7� /� %� <br />ONLDIN6 �"�) 7 / <br />"� r�urnniN, <br />MfG��Nlf.�t <br />•DM�1011M. PUN CNfGN <br />ou�cn <br />I suie eunon+c sunerinnce <br />� CITV OF EVERETT I �U91 �f, WOpNS <br />I LOCAL SALES j <br />� TAX CODE IS 3105 I TOTAL <br />