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-. <br />APPLIC ATIvN FOR CONSTRUC110N PERMIT� <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9f3201 •(425) 257-8810 '��"" <br />p DEMOLITION ❑ COMBINATION � BUILDING �ECHANICAI ❑ PIUMBINf3 ❑ SIGN <br />PROJECTADDRESS: �7�'%S IAI�'rT.Mr�f I�F�. ��� �ZO/ <br />OWNFN LnVN�CiJ {AI• [ir �.�. <br />� � —�k�� f�la\ � "��2� �Ti►1dRF �e, �, -q��.i��t <br />TEN�NI MMI �D SQS � � LITY l�P FIIONF <br />�/ h�>.� <br />�RCHITF.GT OR OES�G��[R M�il �U SS Cliv ]m PNONF <br />DESCMBE WORK �NO SOUIIRE <br />r=-�--'"�w't^�F� <br />oRpPpSEU USE Oi BWIDING <br />LEG�L DESCRIPTION OF PROPI <br />LOf _ BLOCN <br />�— <br />MVOIVED <br />PMCEL TAI! I D. NI/M9En ��� /. <br />,; <br />CONSTRUCT�ON IO�N IENOEP.l1[%ME55. <br />� <br />TYPE OF FlIITVRE <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASMER <br />LAUNDRYTRAV <br />CIOTHES WASHER <br />URINIIL <br />ORINKING FOUNTAIN <br />FLOOF DR�41N <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR, ET <br />or. <br />SUBTOTAL E <br />PERMIT E <br />70TAlFEE S <br />FOR OFFICE USE ONLY: <br />PpONf SFTp�CR PFI1P SFTP�Ck <br />usezor+r ioi�nEn <br />HEIGML I�MITGf10N NO OF UWEtLING <br />11NItg <br />OCCIIP�NCY NO Oi EIORIFi O(:CUP�M 104p <br />FlPE NIARM RW'0 <br />nstE <br />FEE <br />SIpE $EIB�CN <br />wc�r+r Sim <br />❑VES ❑ NU <br />HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br />LONT�CTFFRSON�NOPH(N1EN0 , � � , � � _ <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED TMIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORPECT ALL <br />PROViS10NS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK Wlll BE COMPLIED WITFi WHETHER SPECIFIEO HEIiE1N OR <br />NOT. THE GRIINTING OF 11 PERMIT DOES NOi PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REOULATINU CONSTRUC'710N OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEF OF THIS PROPER TO ERFOPM THE WORK FOR WHICH <br />APPLICATION IS MAD AN OMPLV WITH THE STATE <br />CONTRACTORS LAW 1. 7 R D 96200 WAC. <br />x �f �� � <br />SIGN�TURE b��� <br />C�TY BUSINE55 L�CENSC NO <br />NECH�NICIIL <br />NO. T'PE OF EQUWMENT FEE <br />--T <br />IVC — AMNDLG UNITS <br />FORCED AIR SVSTEMS <br />HEAT PUMP ' <br />UNIT HEATERS � <br />CLOTHES DRVERS � <br />RANGEHOOD <br />WATER HEATER <br />WO00 STOVE <br />GASRANGE <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL E <br />PERMIT E <br />TOTAL FEE S <br />PUNCII[CNNUMpfR �Ff IRfCF��TNO <br />FUIIbIN.. <br />S12E Of BIDGrt� <br />PI UMpING <br />B�SFMENI MFf.��nN1U� <br />OVES ❑ NO <br />nno� i ior+ni. ri �N cnrck <br />on�en <br />Si�ll' fl11110���G SIIRf.lUtit:E <br />CITY OF EVERETT runi ir, wo��Ke <br />LOCALSALES — <br />TAl( CODE IS 3105 TOTA� <br />i� <br />