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<br /> APPLICATIO. FOR CONSTRUCT�..�'N PERMIT
<br /> I� CITY OF EVERETT•BUILDING DIVISION
<br /> I , 3200 CEDAR STREET•EVEREI?,WA 98201 •259-8810
<br />� ❑ DEMOUTION O COMBINATION �BUILDING ❑ MECHANICAL �PLUMBING ❑ SI(iN
<br /> PROJECTADDRESS:�UT <� /vyZ7��� �4(�E -j�+•e �
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<br /> �ER MMLADOi1ESS �ITY 71P PHCNE � I ��
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<br /> 7ENNlT M�IIMOHE55 f.ITY IiP PnW1E
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<br /> ANCIMTECTORDESIGNEN M�IIADDRE55 ��ry � ��p p�E
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<br /> GENEWI�IXINTRI1CTOq MAIL�OORESS LIIY i�l' P�IONE $IREIICENSE� �
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<br /> MECNANICAI CONTR�CTOR t�ADDNE55 CIlY )IP �� PIIONE S �TE U NSE� bQ'�
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<br /> PLUMlIIGC TR/�CTOR MMLAOORESS LIfY I�i' PNONE STATELN:ENSE�
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<br /> �p' O C HEATING SYSTEM: ❑GAS ❑ ELECTRIC O
<br /> OESCIYlEMNPNA SOUAREi00TA0EINVOLVEO (;p�TAC f.1150N�l1D�NE,lq
<br /> � � �� �j�/SvN (zvb) 33 7 -�733
<br /> ' � � 1�o i - 5 78� - 67vo
<br /> � O S� � � HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS ;,��"�
<br /> vnoroseo use oc pna APPUCATION AND KNOW THE SAME TO BE TRUE AND CORFiECT ALL ��
<br /> PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF ` '�"
<br /> � Fr��-f^'-�, WORK WILL BE COMPLIED WITH WHETHEH SPEGFIED HEREIN OR �*��=
<br /> �oaoE ' oFrno�Arr�s�rovmeei aa�rt nvo es� NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESURIE 70 GIVE t��
<br /> iot_,y3_eiocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY ��"�
<br /> �`��� �� � OTH�R STATE OR LOCAL LAW REGULATIN�CONSTRUCTION OR THE 5 ��,+
<br /> yyL. i t.� NW �'� SrG'�"1[X� ZO � PEflFORMANCE OF CONSTRUCTION.THAT I MI AUTHORIZED BY THE r Fyf�.
<br /> / OWNER OF YHIS PROPERTY TO PEFFORM THE WORK FOR WHICH �
<br /> R SE W.M. FCP NU 3- q�a APP��CATION IS MADE AND 1 COMPIY WITH THE STATE .,.t,;�"r;�
<br /> PNICEL TA%I.O.MMIBER CONTRACiORS LAW iB.27 RCW AND 296.200 WAC. ' yr^'
<br /> �J�/ 1 F ?�4R
<br /> CONSTIX/CMINLOAHLENOER.AODIIE55. E r+uuee^ x�r fv ��W�C �/G�ldlOC/ (J I!�%L� - ���
<br /> 0l/1 , �< _Q sicrr un�— DATE
<br /> 02 765v �-'
<br /> CIiY BUSINESS LICENSE NO `�''.'
<br /> PLUMBINfi MECHANICAL . �±,j�p;.�
<br /> NO. TYPE OF Fl%TUpE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE � - -,:�=i;.�F=,
<br /> WATERCLOSET�TOILE� � q/C—A/HNDLOUNRS � �'�,`��`:�
<br /> BATFfTUB ' FORCEDAIRSYSTEMS ; -t�.;,
<br /> LAVATORY(WASH BASIN) � HEAT PUMP , . . -,'�'",''`-";yTt,
<br /> SHOWEH � UNIiHEATERS � ii�j�.4
<br /> ::ITCHEN SINK 8 DISP i CLOTHES DRYERS � ';.�U_
<br /> DISHWASHEfi � Z RANGE HQOD � "� +� " ��
<br /> t:�:i'.
<br /> 'JIUNDRY TRAY ; WATER HEATER ; � :�y �
<br /> Ct.OTHES WASHER � WOOD STOVE � ,�jz- �
<br /> UHiYAL � METALFIREPIACE(WOODBURNING) � - �j••,�`,:�`e�
<br /> DRINX!N6 FOUMiAIN � FIREPLACE INSERT(WOOD BURNIN6) � �'� ? ��'�*y{,�
<br /> FLOORDHAIN � OASFIREPLACE � - ''.i:Y,l,} �
<br /> � BACKFLOW PREVENTERS ; GAS RANGE ; �, , i<<�4jc'
<br /> SINK(SERVICE—BAR,ETC.) � GASPIPING � ��"f�:-.:�'.;���':
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<br /> PERMIT S �— PERMIT S � � .�1"'���°�"'"
<br /> TOTALFEE S ' TOTALFEE S �
<br /> FOR OFFICE USE ONLY:
<br /> FHONiSETBAG( RE�RSETB�CK SIUESETB�CR PUNCIIECNNUMBffI FEF RECEIPTNO
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<br /> us¢zq�E lOT�RE� V �NI SITF. FEES VALUATION � FEE
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<br /> �Y Iq Of 51(YtlFS OCCUPANT LO�D B�SEMENT MFL11nNIC�1 ) �
<br /> '3 .� Z IJYFS NO —" _ I�C i LJ.t�
<br /> FIRESPBINKLERREO'D AFASON �DU�I101UI.PUNCnff.k �
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<br /> FlREALMMREO'D RE�C(X1 .—
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<br /> trve ov r,or�sr ninas�rvnov�o�v CITY OF EVERE7T runi ir,wnnns . � �
<br /> `J LOCAL SALES -- "� ' ��J`�
<br /> _-� u�rE(O 3u q6 TAX CODE IS 3105 TOTAL � I
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