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APPLICATIO.� FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION �OMBINATION ❑ BUILDING O MECHANICAL f�i PLUMBING ❑ SIGN <br />PROJECT ADDRESS:_ 4;, � ,> U % DL �� ,,�i � ��f— <br />��7o�iY� S <br />Mui�poness cm 1m rNpue <br />�GI /i � i20/8 �il/Pl orS�,�l ,. �i��'ri� LF//! f��'�' �3 3 `! 7 - S�d'F�c� <br />! <br />GECHIINICALCONTRIICTOR AMIL�DONE55 J�,VESt�ry <br />�t,�,-rs Pl.v,,.�SIJ G• t4 z2� ,�*^� �a��,,,; <br />PLUhlMICCONTRACTOR A/AllA0DRE5$ Clh' <br />cor,m�cr racE a wanc <br />A� 3DDD °� <br />OESCRIlE NV11K AND 5q1ARE F00T110E HVOLVEO . <br />lEffilil OESCRiP110r10F P110PERTV 13�10wq <br />�or e�oa <br />'—(l/U � <br />IENDER.110011E55. <br />IIP <br />im <br />ZIP <br />�F 4vN�Ttcco�bD3 � <br />- 3Z��/ <br />IONE CIATE IICENSE 1 <br />qNE STIITE LICENSE � <br />��? <br />qNE �,`�`LTS Q� $ 61�.Z <br />HEATING SYSTEM: ❑ GAS � ELECTRIC <br />CONT�GT PERSpJ ANO P{qf/E Np <br />� 4� _ 9�vJ?n 17 .,,✓ .. � L <br />�_ 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINEU THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />9�R/iLMTNRICOPIES� ►�pT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUTINQ CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />ONMEF OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CANTFACTORS LAW 1827 RCW AND 296200 WAC. <br />�a x A�z��i�,s �.��r /. � a y - .2 .S— y6 <br />SK1M�E —T D111E <br />d7YlUSR455l10EM5[ NO <br />NO. TYPE OF FlICTURE OR REM FEE <br />WATER CLOSET(TOILE� <br />BATFiTUB <br />UVATORY (WASH BASIN) <br />SMOWER <br />I KITCHEN SINK 8 DISP <br />� DISHWASHER <br />' UIUNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKIN(i FOUNTAIN <br />FLOOR DRAIN <br />BACKFIOW PREVENTENS <br />SINK (SERVICE — BAR, ETC.) <br />SU8 TOTAL S n <br />FOR OFFICE USE ONLY: <br />vnarrseTn�cx aeursere�eK <br />USE ZONE lOT ARE� <br />IIEI6NT LIMT�TIp/ <br />or r,owsr <br />NO 0: DM�EtUNb <br />UNITS <br />OCCW�NT LO�O <br />o�TF <br />er <br />sioe s¢re�cK <br />V�CANf SIIE <br />❑YES O NO <br />FEE <br />NC — AMNOIA U! <br />FORCED AIR SVSTi <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />RANGEHOOD <br />MEfAL FIREPLACE (WOOD BURNING) ' <br />FIREPLACE INSEqT (WOOD BURNING) � <br />GAS FIREPUCE � <br />IXHAUST FAN <br />SUB TOtAI f <br />PERMIT f <br />TOTAL FEE f <br />Pl11NC11ECMN1IMNFR I fEF � aEf.Fll'f NO <br />BIIIIOMR <br />OF �D6RI <br />PLUMBWC <br />EASEMENT MFCN�NIf.M <br />❑YES ❑ NO — <br />•DDI I ION�L Pt AN G��( G1t <br />on�en <br />STAIE BNlOiNf $IIRCNMKE <br />CRY OF EVERFIT �IIBI If, WOHNS <br />LOCAI.SALES <br />TAX CODE IS 3/05 TOTAL <br />