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APPLICATIC _ J ROR CONSTRUCT. JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-BB10 <br />DEMOLITION fl COMBINATION I1 BUILDING f-7 MECHANICAL rl PLUMBING rl SIGN <br />PROJECT ADDRESS 3 a i� %ZK cCc F c2 R J� � <br />uczE�( ul� g8�o� <br />OMMER MMLADpRESS CITY <br />ti�- y hv� u�F,�s 6�! SG �N� r2�P Po,�T t,u oco�.J cv,� S��G s PHo3 G o �3 7 05�6 8 <br />7ENAN M�IIADORE55 CITY 21p i`MONE < <br />ARCHITECTORDESIGNER M�ILA�DRE55 CITV pin PMONE <br />GENEfiALCONTR�CTO{i MAIL�ODRES$ CITv ZIP PIIONE ST�TEII�ENSE� <br />/�. M, i�vcR,�L �oivSf�ucfo�s /�/L �-i�'i t.v0. /� loS 1v G 33 S/ 79B A�n���n.r. l/o! Kk <br />MECHANIC�LCONiR�CTOR M�IIADDRE55 Cltt ZIF P110NE STATELICENSE� <br />.— � <br />PLUMBING CONTRACTqi M�IUDpqE55 CITY ZIP PHONE STATE UCENSE • <br />CONTRIICT PqICE OF WpRK <br />— HEATING SYSTEM: GAS fl ELECTRIC f� <br />DESCRIBE VIORKl�ND $OUARE FOOT�GE INVOLVED CON7ACT PERSON AND PHONE N0. <br />_� t� � 0 �—T /V B 4 C S <br />PROPOSEO USE OF BUILOING - <br />LEG�L DESGRIPTION OF PROPERtt ISHONT! BELOW <br />t07' �/ /o C/I BLOCK 7G� OF_ <br />(Lc �..�.O.P � � o-Q 30-,( �G <br />3 <br />mninw��vn wnn iervueH, nWRE55, TELEPHONE NVMBER <br />LUMBIN6 <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK d DISP <br />URINAL <br />DRINNIP <br />FLOOR <br />I HEREBY CERTIFV THAT i HAVE READ AND E%AMINED THIS <br />APPUCATION 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. 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 REGULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND COMPLY WITH THE STATE <br />�CONTR TORS LAW iB27 RCW A 296200 WAC. <br />OaG� G�' �-�- �� <br />CITY BUSINE55 LIGENSE <br />AIR SYSTEMS — B.T <br />NP <br />QERS — B.T.U. M <br />I:NIU�7 <br />^'„„` � METALFIREPLACEi <br />' FIREPLACEINSERT <br />:VENTERS i GASFIREPLACE <br />— BAR, ETC.) � GAS RANGE <br />GAS PIPING <br />. � EXHAUSTFAN <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE E <br />FOR OFFICE USE ONLY: <br />iRONTSETBACN RE�R $ETB�LK <br />USE20NE IOTRRE� <br />IIEIGIITLIMIT�110N NOOFOWELLING <br />UNIfS <br />9CCUPANCV Np 0� SIORIES OCCUP�NT LO�D <br />FIPE �LARM <br />SIOESETBRCN PI�NCiIECNNOMBER FEE <br />�� 7 �/ <br />f1YE5 fiNO pUItOWf. <br />SIZE OF OIDGrt.I <br />PLUMOMG <br />BASEMENT MECHRNICAL <br />flYES Il NO <br />n001710Nn1 PUN LHECK <br />OTNER <br />Siq1E OIIILDING SURCIIARG[ <br />CITY OF EVERETT ruour, wonKs <br />LOCAL SALES <br />TAX CODE IS 3105 � 7o7AL <br />SUB <br />S <br />RECEIPi N0. <br />FEE <br />� <br />