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APPLICATION FOR CONSTRUCT�ON PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAH STREET • EVERETT, WA 98201 • 259•8810 •�"' <br />I-1 DEMOLITION f 1 COMBINATION 'yZ BUILDING � MECHANICAL D( PLUMBING f I SIGN <br />PROJECT ADDRESS �� j� � J` t'�� <br />K <br />OWNER MnILnDUR[55 CITV IIP PHONE <br />,. �,Sl� 383$ ��c�P.r E��c.�ff �i'���1 �sa—y325 <br />M41LAbDRf55 CIIY IIP <br />DP pF.51GNGP MAII AppRE55 C11Y 1iF <br />�p <br />�nnr,�on �� n�atlp5 f1(io1 0.3r� rj�T• ti1 cI rY1c['1�1N�5%J ,� <br />0 <br />rvave crnr� i icrr+sE � <br />Mn�LA�DRE55 CRY ZIP PMONE StAtEIICENSE� <br />�Q �� �sc� �� —va�, RiZTS�.L -�1a36G <br />HEATING SYSTEM: f I GAS j�i'ELECTRIC � 1 <br />TAGEI4VOLVEO . _7 � CONT�GIPIRSONANDPIIONF.NO � � <br />70L 7� � <br />�or oiocK _ <br />/1 _ '1 +u� <br />� . , <br />�PARCEL A%ID NUMBER <br />� 7�� <br />CONSTRUCTIONIORN�E <br />0 <br />BELOW IX1 n1TACH TWO <br />TEIEPNONE NUMpER <br />FI%TURE OR ITEM <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASN�R <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />SINK BERVICE — BAR, E7 <br />� <br />SUBTOTAL 5 <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />TONT iFTPFCK PFM G[TO�CK <br />2� , �z�/ <br />115[ ZON� 101 AqP� <br />IIEIG111 U�� NO OF DW�L�NG <br />S� llNlfS <br />OCCUPANCV NO O�S�OFRS IX:LUPANiLO�D <br />nrns�ti <br />1VPEOff,ONST �PIANSMP�V[�Pv <br />SIU[ SETB�CN/ <br />S <br />VACANI SILF <br />i <br />.S 5`/' I / 5 S <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br />APPLICATION AND KNOW THF SAME TO BE TRUE AND CORRECT AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SFECIFIED IiEREIN OR <br />NOT. THE GRANTING OF A PERMIi DOES NOT PRESUME TO GIVE <br />AUTHORITY TO V�OLATE OP CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANfF !�� C�iJSTRUCTION. THAT I AM AUTHORIZED BY THE <br />O':rivtH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON?RACTORS,LAW 1827 RCW AND, 96.200 WAC. <br />X /��/� �t�..�- y-�/-9� <br />SIGNAIURE D�if: <br />aTv nuswess ucervse r+o <br />7VPE OF EQUIPMENT <br />- A/HNDLG UNITS — H.P. <br />ED AIR SYSTE�.AS — B.T.U. M E.A. <br />PUMP <br />1EATERS — D T.U. M <br />HES DRVERS <br />I�ATION FAN <br />WATER HEA" <br />WOOD STO� <br />METAL FIREI <br />FIREPLACEI <br />GAS FIREPL <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FF <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />Pt4NC11ECKNUM�fR fFF'^,D �fCFIPiNO <br />. �S � '-� /�� 'S �l ,� — <br />I V[5 � � �.�. I)UROiN6 <br />SRE Of BLUG� I — <br />5 r 1`lUN3iNG <br />r <br />PASEMF.NL MCCIbWICAL <br />I11[S NO <br />— pppI1104M. PI �N f,11F.CN <br />ou�cn <br />�ID�e BunrnN(i sunamncE <br />CITY O� EVERETT runur. wonres <br />LOCALSALES <br />,. TAX CODE IS 3105 70TAL <br />