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APPLICATIC""� FOR CONSTRUCT��N <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 96201 • 259•8810 <br />p pEMpL1T1pN ❑ COMBINATION ❑ BUILDINO � MECHANICAL <br />pROJECT ADDRESS: <br />PERMIT� <br />❑ PLUMBING ❑ SIGN <br />IENAMT <br />u�u�woaess crtr ziv PIIONE <br />�pp111EGTOR0E5KaNER MNIMd�E55 GIIY IIP , PNONE <br />OENEMICONIMCTOR MUL1100RE55 <br />GITY I�P �MONE SGTEIICFNSE• <br />1QCAL CWE�c�o�t ��+�—��5�-�- ��1a� 4�,+� AvE W Lv►�woo� �+8o3t� =QEALES0f�6 \ F� <br />STA E IICENSE <br />PLUIlNGCUM1N11CTOR M/J1/�00NE5S CI1Y 2�P PIqNE STAfEIICENSE� <br />FpOTKrE <br />LOT �� � <br />�.,�,o.�a4��3- 004- oa5 • <br />CONS7IMIG110N 101W LENOER. �DDNE55. TElEP110��E NU1AlEN <br />�� <br />NO. TYPE OF Fl%TURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATFiTUB <br />LAVATORV (WASH BASIN) <br />SFqWER <br />KRCHEN SINK 8 DISP <br />DISHWASHER <br />UUNORY TRAY <br />CLOTHES WASHER _ <br />FOR OFFICE USE ONLY: <br />iHON�SETBACN REMSETMLK SIDE <br />20NE <br />11EI6HT UMT�TION <br />HEATING SVSTEM: � GAS ❑ ELECTRIC ❑ <br />cONTACr vEaSON AND PHONE NO 1 i _ .. . �L I. n� .L� <br />lOt AREl1 I V/iCANi SITE <br />❑YES O � <br />r+o a rnvEwrxi <br />UNITG <br />o�re <br />SIiE OF BIWRI <br />❑YES ❑ HO <br />CRY OF EVERETT <br />LOCAL SAIES <br />TAX CODE IS 3105 <br />I HFREBY CERTIFY THAT I Hi.VE 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 SPECIFIEp HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT �FIESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINf3 CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br />ONMER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLV WITH THE STATE <br />CpNTRACT RS LAW 1827 W AND 296.200 WAC. <br />�,,� � _ � — �� <br />5 N�TIM� DATE <br />CITV BUS�NE55 LILENSE NO <br />AIR <br />SUBTOTAL f <br />PERMIT 3 <br />FlANC11ECkNUMBEI�n fEF IRFCEIPTNO <br />Bltll��Nf, <br />P/UTABING <br />MECN�NIC�I <br />�DpIIONAL PI�N CNf.CN <br />�� <br />O�NER <br />Si�IE BUIlOINf. SUnCH�RGE <br />PIIBI If. WORNS <br />TOTAL <br />