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� CITY OF EVERETT • BUILDING DIVISI(" <br />320. : EDAp STREET • EVERETT, WA 98201 •�o9-B810 <br />❑ DEMOL.ITION ❑ COMIBINATION ❑ BUILDIN(i ❑ MECHANICAL ❑ PLUAABIN(i ❑ SIl3N <br />PROJECT ADORESS: �-c� � G 5 ii-17 E S i� ��t��'[.=tT uli9 <br />'U,LC,r��.,-, T, �'NrKTy a�a(�si/+ir Gvc�2�7,•,ui�s/, 5'�ae� 33 �-a-�s � <br />�� MNL�OORE55 dtt T�P M10NE '— <br />iEIUNT YNLJIOdiE55 CITY IIP MqNF <br />�1[CTd10E5N'.NEF Mul�OIX1E55 f.ltt lm PMONE <br />OENEMlCON7R�CfOf1 MM1A0011E55 CrtY lIf` PIIONE $I�TEIICFN5E1 <br />Ou�N� <br />MELMANiL/iL LONTRACTqi YIJI A�ORESS Ci7Y IiP PIIONE ST�iE IICE. ,E � <br />PWMMr000�7fNK'TOR M/JLAOp1ES5 LIfY ZIP PllplE ST�TEIICENSE� <br />UESG�YlE MVIIN I1MD SdU111E fOOTMsE klVOIVED <br />r"; <br />lF(i/iL OESaMPf0. M OF A1oPEnn (S�qvMlElow Oa �rr11cN TWo <br />�or eipcK � a _ <br />/MICEi TIU(1 O. MILIlEp <br />OONS11M1CTION IOM/ LENOER.I1Dd1E55. TELEP110NE NUA1lER <br />�V�� <br />N�. TYPE OF FlXTURE (1R ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />DFIINKIN6 FOUNTAIN <br />FLOOR DRAIN <br />BACKFlOW PREVENI <br />SINK ISERVICE — BA <br />FEE <br />SUBTOTAL f <br />PERMIT f <br />TOTALFEE S � <br />FOR OFFICE USE ONLY: <br />iROMTSETRl1GI REMSFTB�GK SIOESETBACN ' <br />USEZUNE IOI�REA WC�NfSpE <br />OYES ❑ NO <br />11EIG11TUMIT�TION ryp pppW(�p�. SIZEOfBIbGRI <br />IINIIS <br />� S�(HbfS <br />❑YES ❑ NO <br />HE:.TING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CON1�Gf PERSd1 N10 PIqNE Np <br />I HEREBV CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br />APPLICATION AND NNOW THE S11ME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNIN(i TNIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTIN6 OF A PERMIT DOES NDT PRESIMIE TO 61VE <br />AUTNORI7Y 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR IOCAL LAW REGUTAiIN(i CONSTRUCTION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU7MORIZED BV THE <br />OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x�.�� 6��'�i�-� o� -or5'�` <br />SM.NA71111E O�TE <br />CITY BU5NE55 UCENSC NO <br />NO. I 7YPE <br />MEfAL FIREPLACE �11000 BURNING) � ; <br />FIREPLACE INSERT IWOOD BURNINGI . �� <br />P�ANCpCf.NM�MPf11 � fFF � RECfIPT <br />BUIIOINfi <br />P1111A0Mp <br />MECII�NIC.�I "—_ <br />M>O�IIONA�. PI �N C�llCx <br />on�en <br />sute eunowo suncuencE <br />i'lANSMPROVEDBY CITY OF EVERETT MIPIIC WOPKS <br />LOCAI SALES <br />,,..� TAX CODE IS J105 TOTAL <br />