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APPLICATION FOR CONlSTRUCTI�..� PERMIT�� <br />CITY OF EVERETT • OUILDING DIVISION <br />3200 CEDAR STREET • EVC-RETT, WA 98201 • 259-8810 <br />❑ DEMOUTION ❑ COMBINATION fl BUILaING �MECHANICAL Cl PLUMBING fl SIGN <br />PROJECTADDRESS ;�,,,.� ,,, �, ,_ ,,,, ,,,,� I <br />AW11100RE55 Gltt 21P P�E <br />MLHITECTONDESIGHEH M/JL60DRE55 Cltt ZIP P�E <br />GENERALCONTMGTOIi MlJLADOAESS CITY ZIP PMONE ST�•7EUGEN$E• <br />INVOWLO <br />j / /� <br />rsna+m ettow <br />l0T BLOLK <br />CONSTRUCTOH IAAN LENDLA. ��EEiS. TEIEPHONE NUMBER <br />PLUMBING <br />NO. TVPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATOHV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINK�NG FOUNTAIN <br />F�OOR DRAIN <br />SUB TOTAL S <br />PERMIT 8 <br />TOTALFEE $ <br />F09 OFFICE USE ONLY: <br />FROfIT SETB/�CN PEAR SETBACK <br />USEZOYE lOTAREA <br />MEIGMTUMITATION NOOFDWEWfY3 <br />UNITS <br />o�Te <br />SIOE <br />HEATING SYSTEM: �1 GAS O ELECTRIC f_7 _ <br />WNTACiVENSON�NDPN.�NENO. /����^�^,A �/M_ <br />/ F-i t�Ni L� L <br />I HEP,�BV C[RTIFY THAT I HAVE HEAO AN� E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNiNG THIS TVPE OF <br />WORK WILI. BE COMPLIED WITH WHETHER SPECIFiED HEREIN OR <br />NOT. THE CRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITY TG VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS ?FiOPERTY TO PERFORM 7�HE WOfiK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITM TME STATE <br />CONTRACTORS LAW 1827 flCW AND 286200 WAC. <br />X�^ d �� �--�Zg'�i(J <br />SIGN� RE DATE <br />CITY BUSINESS IIGENSE N0. <br />TYPE OF FI%iURE OR ITEM <br />— A/HNDLG UNITS —� H.P. <br />iCED AIR SYSTEMS — Ii.T.U. . <br />�E�A�I <br />GAS RANGE <br />GAS PIPING <br />SU� TOTAL 5 <br />PERMIT 5 <br />mia� FEE 5 <br />PUN fJIF.GY �WM�i�f FEE I RlCEIFi NQ <br />V�CANi SITE <br />flYES n NO BUIIDING <br />OF BIDG�f.I. <br />pLIUBINO <br />BASEMENT MLCNNAGAL <br />❑ YES ❑ NO -"'" <br />AD011101lA1 � <br />OTMER <br />ST�IE BUIIDi <br />CITY OF EVERETT ruei�cwoares <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />�ECK <br />�qCMMGE <br />