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� <br />� <br />APPLICATI�.N FOR CONSTRUCI iON PERMIT �,�}� <br />CITY OF EVERETT • BUILDING DIVISION r/�,r <br />3200 CEDAR STREET • EVERETT, WA 9B201 • 259-8810 �C� J-- <br />O DEMOLITION ❑ COMBINATION �BUILDING LI MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT,ADDRESS: 80b a WIOIC �Lud • <br />... �-f. � � n , ..� . ���. �1L ��2�� 7CQ-17 iQ � <br />v n� p ' --'- - <br />TEN/J!T MMl�fII1f�F55 GItY /It' <br />_.__.. . . . .__ <br />ARLMTECTOROESIGNEn � MAII ADOnESS Cltt %u' PIIONE H�USC H- � 2� <br />Rp�,ro 1-Inhn 14•;��oi.intr�ubb+-- �_�►'1� .Cig-2�-2�-�--�'S�_2S2S <br />SIAIE IICENSE • <br />6ENE AILONID11Ct0f1 MAlLAD00E55 �- GIY ^ .I''' �� ���ONC � � <br />�� <br />�„ ��1sa (',��.�.,��, r ��1--'-�, W,<.�U ;oa�! <br />MECHulICALG PACTOP MMlAD0�E55 CIYY Ii�' PIIONE SiATEIiCENSE� <br />N.F� . /-1�s��,-�,�,i�.� � � <br />PIUMBMGCONTNAGfOR M�ILAW�E55 GI�Y iIP PIIONE SfALEIICENSE• <br />�\ r <br />c«+tiucrvwceorwon� C 00,a _, ��S �{EATING_SYSTEM: ❑ GAS LECTRIC ❑ <br />OEs� SEYNRNANOSOUAREFOOIAGEINVOLVEO ` CONI�CiPCfISON�N�PHONENO <br />( -hnv�no nOrGlG�o �'�X'nCQ _ 1 --- <br />vnoposeo use a euaar+c ` , � . <br />IW <br />1E61110E5CIMPTION OF %70PERtt 1�� BEIOW OH A7 <br />ioT �_. e�ocK oF� <br />�.I <br />`�104'! OQD (71��'y GDo� <br />CpNSTpIICTON l0� lEN0E0. ADDRESS. 7ELF%10NE MU <br />r� , <br />PLUMJIN6 <br />Np, TYPE OF fl)fTURE OR ItEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCMEN SINK 6 DISP <br />DISh'WASHER <br />LAtiNORY TRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKIN6 FOUNTAIN <br />FLOOH DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSE70ACK AE�R SFTP�CN <br />�L O <br />USEIOME� 1 101AREA <br />NEIOHi IIMIT�TION <br />REO'0 <br />NO OF OWEILING <br />/ UNIi$ , <br />�� <br />TOTAL S <br />NIT f <br />or <br />� <br />FEE <br />SIbE SETB�CK <br />S <br />V�CANI 9iG <br />pYES <br />S�IE OF BIOGR l <br />OYEs m'�+� <br />CITY OF EVERETT <br />LOCALSALES <br />TA% CODE IS 3105 <br />I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIUN 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. TI1E 6RANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTI�IORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STAtE OR LOCAL LAW FlEGUUTIN6 CONSTRUCTION OR THE <br />PERFOPMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW A 6200 WAC. <br />x_ 1'1,t,c�,Pd, �'-2/-G'i7 <br />SIGNMUOF. DATE <br />CItY OIISINF.SS IK:ENSE NO <br />TYPE OF EOUIPMENT _ FEE <br />A/C —M/NDLQ UNRS <br />FOf10EDAIRSYSTEMS _ <br />UNIT <br />��� <br />TOTAL <br />S <br />S <br />r�nNcii�N.��%� IrEF�% _/ nEf.E�rTNn <br />LlS <br />OIIIl11Mfi <br />PIIM111N--_ "--- <br />MFCII�NIf.�I <br />nuun�oM�� r�nHC��rf.K <br />onien <br />S1n1G mnllunG!aI11qUI10E <br />r1�n1�Cw011nc _ <br />TOTAL . .- � --- <br />nv <br />SJ <br />