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'� APPLICATIO.� FOR CONSTRUCT, �N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-H810 <br />❑ DEAAOUTION ❑ COMBINATION ❑ BUILDING ❑ INECHANICAL ❑ PLUMBING ❑ SIGN <br />�.. � � <br />PROJECT ADDRESS: <br />�Fe.'rnn � 71.-n ., � <br />�$-1' <br />PIU�bRK'iCONTN�CTOq MulA00i1(55 CIiY =In P1qNE St�TEIILENSE• <br />�ND Sd1ARE FOpTl1GE INVOIVED <br />ioT aioac a <br />,�c+,l�C' CLG(OC.Nr/ <br />vNncE� r i.o. Mn�s¢n <br />� 70 � O/� 030� <br />CONSTINlCTION IONI LE/AER.ADD11E55. TElEP11dIE NUAI9ER <br />�V��� <br />NO. TYPE OF fl%TURE Op ITEM <br />WATER CIOSET (TOILEn <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />OISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKIN6 FOUNTAIN <br />ROOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />SUB TOTAL <br />FOR OFFICE USE ONLY: <br />iqdlTSEtB�CK PEM! <br />USE ZONE� _ � �p� <br />NEIOIITIIMIfATION NOOF <br />�!1 UNIf$ <br />HEATING SYSTEM: ❑ �aAS <br />LON7AGT PERSON I1Np PIIp1E Np <br />0 <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COppECT ALL <br />PROVISIONS OF UWS AND OROINANCES GOVERNING THIS T:'PE OF <br />WORK WILL 9E COMPLIED WITH WHFTHER SPECIFIED HEREIN OR <br />NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW pEODUTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSiRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNEti OF THIS PROPEflTY TO PEHFORM THE WORK FOR WHICH <br />APPLI ON IS MADE AND I COMPLY WITH THE STATE <br />CONi AC ORS LAW 1827 RCW AND 296.200 WAC. <br />x �a �.�/� ��1� � l9� <br />SIGN�T D� E <br />Cltt BU9NE55lILENSE NO <br />AIR SYSTEMS <br />. <br />S�DESET9ACk P��NG�ECRNpMPffl <br />7 � �- �5 Sa�1a` <br />� V�C�NT S�tE FEES <br />_ ❑r¢5 �o nunnwc <br />512E OF BIDC/f I <br />�ot 5,�. aPal. 3s� S.F rwMeiNc <br />F <br />B�SEMEHT (�AIIAG� MECIUNIf,�I <br />❑YES p1� <br />•D01 flpN� � PUN �N(.CN <br />Ob�ER <br />INSERT <br />FlREAIMMREO'0 RF�S(ki � <br />ST�IE 901LOIN6 SIIItC1UpGE <br />iYi'E OF f.ONSt rinvs �rvnoyE� CITY OF EVERETT �Ilql lf, WOpNS <br />'J LOCAL SALES <br />�/�/ o�rE 5�14�5� TAX CODE IS �105 TOTAL <br />SUBTOTAL S <br />PERMIT S i <br />TOTALFEE f � <br />fEf fi{ f.EtPf NO <br />ao . �� <br />VALUATION FEE <br />3s 7t� � �39</ ! - <br />