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APPLICATIOL��FOR CdNSTRUCTI�N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-88t0 <br />p DEMOLITION ❑ COMBINATION Jj� BUILDING � MECHANICAL ,� PLUMBING ❑ SIGN <br />PROJECT ADDRESS:�_3 �,�.i� <br />6�loO�, <br />ONTlER MeIlMlqiE55 Cltt IIP PIIONE <br />�w�..�_u j�-G --=� �c:�.2� nZ-38K a�, ��.�i9Re3L 35Ca 24' . <br />TEN�NT' MNlMC1E55 � � CITY 71P <br />t r i, P��ONE �� <br />♦�RCM.rt�ECTOROESIGNER AI�IIADD�E55 Cltt IIP PHpNE <br />rrn l. IC� N Q� �'i ��'i!%� �\/l� 16G_ y'1 R2 <br />MULADDqESS <br />71r <br />PnONE 5*�tE uCENSE • <br />PLUMBINGCONTR�GTOR YMlA00HE55 CIfY ZIP PNpNE ST�TELICENSE� <br />AND <br />l0T �� BLOCN <br />INVOIVEp <br />CONSiRUCTON, bLOAN lENOEP, �Op1iE55. IELEPIqNE MIMBER <br />L�`• � � � 41VT�+�^� � �KM✓F<f� <br />Pe-F �- 't-� S-5�z.c <br />PLUMBING <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CIOSET (TOILEn <br />BATHTUB <br />3 UVATORV �IVpSH B.4SIN) <br />SHOWER - <br />/ KITCHEN SINK 6 D1SP <br />DISHWASHER <br />UUNDRY TRAY — <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FIOOR DRAIN � <br />BACKROW PREVENTERS <br />SINK (SERVICE — BAP, ETC.) <br />SUB TOTAL S � <br />PERMiT S � <br />TOTALFEE S � <br />FOR OFFICE USE ONLY: <br />fRONTSEiBACK RE�RSETfi�CN <br />� _ 'i.E) <br />USE 20N �/ ,� LGT �REA <br />�`_J C' � �L`-Li <br />NEIGHTUMI�TIp�! � NO 01 DWEL4N0 <br />LV UNIfS � <br />OCCVPANCY NO (It St(MtlES OCLUP�NT IO�O <br />❑�rE <br />HEATING SYSTEM: (� GAS ❑ ELECTRIC ❑ <br />CONT�CT PERSdI �NO PHONE NO <br />1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br />PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CQMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT OpES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCqL LAW REGUUTING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CANTRAC ORS LAW 10.27 RCW AND 296200 WAC. <br />\ _ .� <br />an eus�r+ess <br />T'PE OF <br />I.�I�7 <br />WATER HEATGR <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACEINSERI <br />GASRANGE <br />GAS PIPING <br />SIpESETB�CN PIANCHELR <br />�� �o � � <br />V�CA�N/i gIfE <br />JdYES ❑ NO <br />OUIIDING <br />1� P�. <br />Si ,� L�vw4 + riuuoiNc <br />s.r. GnaAc:.E <br />B�SEMENT � MEC1uNIC�L <br />❑YES �NO <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE S <br />'11 fEF REf.I <br />%9 ��� 2i <br />�DDII IONAL PI�N �IIfGN <br />omen <br />SiAIE OWIDING SUtIC1U0GE <br />CITY OF EVERE7T Pllplif, WORNS <br />LOCAL SALES <br />TAl( CODE IS 3105 TOTnI <br />� <br />� <br />