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APPLICATI` N FOR CONSTRUCi .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDINQ ❑ MECHANICAL ❑ PLUMBING ❑ SI(iN <br />PqOJECT AODRESS: ( 8�2 / I z'4 5` <br />ONTlEN MiUl�00RE54 CItY IIP p�qr�( <br />��r✓� �;,"�otni lbyo5' SNiv,� PT[��•� 9��,,,��c., l�Zz3 36� ��5/ ��i17 <br />1EIUNI YulIJ1d1F.55 fd1Y 71V PIqNF <br />// � <br />�/ . � <br />3/ . 3 3 -ZY3s' <br />A TCCIOROESIOMEII M�II�Od1E55 CIIV )tP PNpNF <br />! C 5 ,9� !'d u� � i� � <br />e!A[1�1TCOMiIUC/Ot1 M�II�UlMIF55 f.IIY 7�� Pil(N1E CI1qElICENSE� <br />��g••r �yo�, l YoH SnrMr /'% Rt�p �rt �-e-, `14Z23 3�0 LS�i-Zi17 <br />MECNN11�1LLCONTMGlp1 MNl�U0NE55 dfV 7�� P110NE SUfEIICENSE� <br />PLU4MNGCONIRAt;TOR 4�I1�0011E55 CIIY rlP PIqNE SGfEtN:ENSEI <br />Cp1TPM:f PRICE Oi Wd1N <br />DEBCIMlE WORM ANO SqURE FOO <br />Pc�cc jrc;,,.c vn <br />I/nri i < O/c Hw� <br />i � �)� <br />rnoroseo usr. a nuidra <br />Te��4c <br />�aa ocscrnvtiw a nrr �! <br />l0T MOCM _ <br />n�vuivco <br />� on r�..•.;r� ?ZCsu[ �«T <br />�dv �'o� <br />�xl':��li� Jl�-iC,n.� <br />'_U9l�,� � �. <br />r�qcr�r�xi.o.Mlue¢a <br />CONSif111CT10N lWll LENOER. Md1E54. TFLEPIIp/E NU4DER <br />PLUIMe1N0 <br />NO. TYPE OF FlIRURE OR ITEM <br />WATEF CLOSET (TOILET) <br />BATHTUB <br />UVATORY (WASH BASIN) <br />6FNOWER <br />K�TCHEN SINK 8 UISP <br />DISHWASNEA <br />L�UNDRYTRAV <br />CIOTHES WASHER <br />URINAL <br />�RINKINA FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINN (SERVICE — BAR, ETC.1 <br />SUB TOTAL t <br />PERMIT f <br />FOR OFFICE USE ONLY: <br />ff10NT5FTBACk IIE/JI$FiM(;M <br />use zor� <br />IIEIONT IIMiAT10N <br />��� <br />� <br />iorenc� <br />MO Of MNEll11q <br />UNIIC <br />OCCUPI1Nf 10�D <br />envnrnr n er <br />JM, i. <br />SIDE SET&1CK <br />HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br />coui�c� vcasor� �rm rHOHc rq <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFHECt ALL <br />PROVISIONS OF LAWS AND ORDtNANCES 60VERNIN6 THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW RE�ULATINO CONSTRUCTICN OR TME <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTNORI2E0 BY THE <br />OWNER OF THIS PROPEIITY TO PERFORM THE WORK FOR WMICM <br />APPLICATION IS MADE AND I COMPLV WITH TNE BTATE <br />CONTflACTORS LAW 18,27 HCW AND 2B8.200 WAC. <br />%C// �� /n-�r,_r��_ <br />CITV BUSNESS IICENSE Iq <br />NO. I TYPE OF <br />FORCED AIR SVSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />METAL FIREPLACE <br />FIREPIACE INSER' <br />GAS FIREPLACE <br />M�N CIIEC� NU,ARnFn <br />��C, �� <br />WC�Nf SiIE reen <br />nres ❑ ra e�moir�a <br />SIiE Oi lIOM I <br />Z �J , ,�'fLf PIUMNINO - <br />/F% <br />l�SEMENI MFCN�Mf.�l <br />❑YES �NO — — <br />�DO� IIUN�L Pl �N CIIf.CN <br />Ub�flt <br />Sl�l! Rlnlp�NO51111CNMNfE <br />CITY OF EVERETT ruro �r. wnn�c <br />LOCALSALES — — <br />TAl( CODE IS J105 TOTAL <br />SUOTOTAL f <br />PERMIT f � <br />TOTAL FEE f ' <br />rer nrcFm�ra <br />V�LUATION FE <br />�l�q2 i I �� <br />� <br />