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APPLICAT16r1 FOR CONSTRUCT�ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />f� DEMOLITION fl COMBINATION fl BUILDING f-I MECHANICAL r� pLUMBING fl SIGN <br />PROJECTADDRESS y—O�/ ������ / I��j <br />l�rr- �l��rPe-/�, wf} - <br />OYMEP MMLADOPE55 dtt 21P nunuv <br />MULRODRE55 <br />f.ITY <br />�RCNITEGTOR�ESIGNEP M�IUDORESS �ITv IIP PHONF. <br />w,�r//ti_..xs_ �l��re���r���.�i�v�a-,��„� ��u.�• p�z o�- - �"ZS37`G <br />GENEpM �Ciqi MMI�Dl�RE55 CIfY 21P PHON[ GLeiLL�ICE�NSE• <br />MECNANICMCONTRACTOR M�ILAD�RESS CITV Zli' PIIONE STATFIIr E 5� � <br />PLUM9INGLON7R�f,TOR M�IL�DORESS Cltt 21P PNONE STRiELICENSE� <br />�or <br />r PRIGE OF Wdi <br />3. ���. `' ° <br />WORK �ND SOU�RE F T�GE INVOIVED <br />Fi��� <br />s� ,4• %c /?�6, F <br />' A lz ��/P% . <br />1 U5E OF B lDIN6 <br />�CRIPTION OF PROPERtt �5lqNTl BELOW OR <br />BLOCK OF— <br />CONSTRUCTIONLOI�NLENOEP.ADDRESS,TEIEPHONE NVMBER <br />PLUMBIN6 <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CLOSET (TOILEn � <br />BATHTUB � <br />LAVATORY (WASH BASIN) , <br />SHOWER � <br />KITCHEN SINK 8 DISP � <br />DISHWASHER � <br />LAUNDRYTRAY � <br />CLOTHES WASHER � <br />URINAL � <br />DRINKING FOUNTAIN ; <br />FLOOR DRAIN � <br />BACKFLOW PREVENTERS ; <br />SINK (SERVICE — BAR, ETC ) � <br />S <br />a <br />FOR OFFICE USE ONLY: <br />FRONTSETP�CN RE�R SFT811CN SIDE SETP�CK <br />USE20NE <br />MEIGNT LIMIT�iION <br />OGCUPANCY Iq pf� <br />GRIXIP <br />�A ALARMHE00 � <br />PIRF. SPRINKI.ER RFO <br />TYPF.Of f.ONSI <br />IOT�RE� <br />NO OF UWELLING <br />UNIIS <br />f'1 �NS <br />V�C�Ni SIIE � � <br />f1VE5 f(iN0 <br />SIIE OF BIIXi? I <br />IIVE$ I1 NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />�TING SYSTEM: f 1 GAS fl ELECTRIC fl <br />CONT�CT VERSON AND PHONF NO <br />I HEFEBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION 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 RE6ULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTHACTORS LAW 18.27 RCW AND 296200 WAC. <br />x � � �i(P1?l1� V /O-5l �5 <br />SIG RE O�TE <br />CITV BUSINE55 LICENSE NO <br />� <br />— B.T.U. M E.A. <br />— B.T.U. M <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAI S <br />PERMIT E <br />TOTAIFEE E <br />PLAN CIIECN OM9ER cFE PECFIPT NO <br />� �� <br />FEES ..4LUATION I <br />Bllll �ING Q � L% � <br />PLUMOING <br />MEC�I�NIGL <br />4DDI110NAI. PIAN CNf.CN <br />OiNEB <br />STRTE BOIlOM6 $URCIIAIiGE <br />ruanr,wonRS <br />TOTAL <br />