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APPLICATION FOR CONSTRUC7.ON PERMIT�w%� <br />CITY OF EVERETT • BUILDING DIV(SION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOLITION fl COMBINATION I�BUILDING Il MECHANICAL �, PLUMBING f� SIGN <br />PROJECT ADDRESS <br />i l/„ C�L.�l,HPIC (ZLv4 ��1E�cE-rT , Wsl �(�Lc-3 <br />OWNER MRII�WNE55 GITV 21P �•nurvt <br />�' Js�,,�kin�sonl Z`}'3 ELN �T �z-4 EJ�KCTf q�Zo 3 2SY -344.� <br />TEN�NT MAIL�ODRESS CITY ZiP P��ONE <br />ARCHITECT OR OESIGNER M�II. AU�RESS CITY 71P PIIONF. <br />�20� _eNr G�6.__o��MP�� �c.�o e�K�rr 9�zAz ZSk-9i 6 4- <br />��,� ;m ri�or+c c�ntEucrr+se. <br />S�L � <br />MECH�NICRICONTRACTOR M�IIADDRE55 CIN ZIP PIIONE $TATEUCENSE� <br />PIUMBINGCONTRIICTOR M�ILADDRE55 QtY ZIP PNONE STAIELICENSE� <br />,�SEc.r <br />cor+rR 2.PR10E OF WO � HEATING SYSTEM: GAS rl ELECTRIC �l <br />.�� - � � �` / S�-� <br />OESCRIBE N'ORK �ND SOl1ARE FOOT�GE NVOLVED CONTPCT PERSON �Np PIIONE NO. <br />Pf10PO5ED USE OF BVII[Hr+ci <br />S�rJ(,�� fa�-.�cY IZES• <br />LEG�L OESCRIPTION OF PROPERTV (SHOYM BE <br />tor S8 e�ocKo�-�-oo <br />.,,..,,«,.y,t�/�'UOD -0��.� - DUO� <br />CONSTRUCTON LOAN IENDER. ADOfiE55. TElEP110NE NUMBER <br />PLUMBINQ <br />NO. TYPE Of FlICTURE OR ITEM �E <br />y. WATER CLOSET (TOILET) <br />Z BATh'TUB <br />?i LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />� DISHWASHER <br />LAUNDRYTRAY <br />� CLOTHES WASHER _ <br />URINAL <br />DRINKING FOUNTAIN <br />FlOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) _ <br />PERMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />fRONTSFTPACN _/ RERRSF.iBRCR / <br />�� /1 �%% � <br />�/C� �_ <br />USEZONG J/ IOTPREA <br />HEIGMT UMIT9t10EL j jjNli� UWELUNG <br />/J lL <br />CV NO Of S�OF�[5 IX:CUPFNI NAv <br />' I R <br />IM,NFEOII RF�SON <br />/� <br />NK/I�F�.R�RW➢ AF�FOY <br />N�/ <br />,^,pNSi PIANSRPPPOVEDDY <br />� JM <br />�A,E 9�1�/ <br />$ ;$ � <br />$ <br />$IDE SETARCe <br />V�C� 511 _ / � <br />IIY[5 f:YO <br />���`"�'��yi��`��/m�0�/�%�� <br />� �/f N1Y�G n1'N � <br />B45FMENi <br />ii�cs M r+o <br />��G/� �tP/'� <br />I IIEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE UF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONT TORS LAW 8 7 W AND 296.200'NAC. <br />x �'"�«�• ���`' "� � ���� 3�9 s <br />SIGN�TURE �pTE <br />CITY BUSINE55 UCENSG NO <br />AIR SYSTEMS — B. <br />UNIT HEATERS — B.7.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />/ I �I AN <br />CITY OF EVERETT <br />LOCAL SALE5 <br />rax cooe is aios <br />ouunn+c <br />PLUN@MC <br />MGCN4NIC�L <br />ApUI110NA1. 1'1 r1N CH(CN <br />OiH[R <br />SiAI[ FIIIl01NG SURC�iA�GE <br />ruei ir, wonres <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TUTALFEE S <br />=1�� /, G�� <br />f[f RfCFIPi NO <br />/��%,�� <br />FEE <br />