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APPLICATIO� FOR CONSTRUCT�ON PERMITV��}1. <br />CITY OF EVERETT • BUILDING DIVISION C/'�'�1— <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 �C� <br />I I DEMOLITION ; I COMBINATION � i BUIIDING i I MECH.4NICAL ' PLUMBING i! SIGN <br />PROJECT ADDRESS q , ( <br />�i i S — � 'Sn ,-1' � � -� �. ) . � i ) � �1 � t n <br />owrven unaedonrss an ;m rr�enr <br />S�'�� i-�'cCca.r3 /��.��c S�Y�=.��� �� ,�f/t,A'n.7� 4,.h rt'r`r= rf`�'`/z�f _ _ <br />iPN�NI Mnll �M)nr55 [ilv lln r�u�at <br />MCIIIT[CTORDE516!N�E� M�II�DORE55 Crtv 7i� I'HONF <br />.�� �iia� r�f C,��� � f`I�S �47._.(/�-ti�j Ll�u.�M�..I�f l�_�L1T ._�� C". �f��� __.. <br />r.eNcnu coNm�r,ton M�n �ounrss cnv nr rnoNr cinn urr�+sr . <br />�C{� lili/[c�•I'm�.,!!.�< 1`!(tL'(.� i�S���•5f S/L.��fl�isN Q'1%�`75e' iZf YI/1 �C(�U�C ��R�SJ'et� <br />MFf.1UNlf.l11 f.ONiR�f,iOp � M�il �bD�FSS f.iiv lIP P110NE Sinff 1�CENSE � <br />F��tl/�� ��' �"1.'r /Y-/ �'ih'vr� iir' u�/ jF�r7a !.s S �src , !✓/1i�<<�!�/L£�'� — <br />riuMaiaer.oNin�r.Tori u�nnnoaess cnr nr rr�or+e suicueFr�sF. <br />il.. �.t.._..J ..�.�..L, .. r. c >../� n..� .,., n....��..r.,.- ye; �/ L L�2. L�/1•: n-=dTrJ P[ e�!'}",f n' <br />OE',CPIOE W0f1N 11ND SWARE FOOUGE INVOI VED <br />iEc�� oEscmrnor� or vrrorenn isrmww aeiow a� �rucN rvro cories <br />ioT �' eiocK or /�� S Gi �fr 2�c <br />1 <br />��vu - ouE, - ���, ��Y <br />IO�N IENpEA. �M1RF55. TLIEI'11pNE NOMPEII <br />. �..�_.w. iu�i� f�t(� � <br />TYPE Oi <br />WATER CLOSET <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER i <br />URINAL <br />DFiINKING FOUNTAIN <br />FLOOR DFiAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAH. ETC.) <br />FOR OFFICE USE ONLY: <br />rnortt sFt ��.K� � nron sr�A� / <br />IISf lONF �_ 1 � I OI �f1[� <br />IIf.�G111lIM1i�11 N / r1p lX I�Nf.ILINC <br />I�Ni15 <br />UCCUP�NCV 1M n� cu�mJ S l%:CUPANI IO�U <br />I:IIOII -- � <br />�' 3 2 <br />nneq�num.an i�rns�w <br />flfiFSPOINMIfOPFOfI �if��CN <br />tvrFnrco�+c� ��inNs�rrnovfr <br />�-N __ �„�F ��l � <br />FEE <br />HEATING SYSTEM: ;� GAS � I ELECTRIC f'� <br />r.ornec+ rrnsoH nr�n r��o�+r Ho <br />I HERE�Y CERTIFV iHAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO �E TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AIID ORDINANCES GOVERNING Tk{IS TVPE OF <br />WORK WILL BE COIdFLIED WITH WHETHER SPECIFlED NF.i�FIN OR <br />NOT. THE ORANTING OF A PERMIT DOES NOT PRESUMC- TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULATINC� CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNOR12EU BY THE <br />OWNER Of THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH ?HE STATE <br />CONTRAC?�7H$ LAW 1827 RCW AND 296200 WAC. <br />X`�'�C�<' � /G ��"yS- <br />�CNi�IURE ��if <br />CIIY 6USMF.551 ICENSC NO <br />TOTAL S � <br />d1T S � <br />�L FEE S � ' <br />� <br />sioesern�cx � rin�� <br />TVPE OF EOUIPMENT <br />A/C — AMNDLG UNITS — H.P. <br />FORCEDAIRSVSTEMS—O.T.U. M <br />HEAT PUMf' <br />UNIT HEATERS — �.T U M <br />CLOTHES DFVERS . <br />VENTILATION FAN <br />RANGEHOOD <br />WAiER HEATER <br />WOOD STOVE <br />METAL FIREPLACE I <br />FIREPI.ACE INSFRT <br />V�C�N� clif rc�o <br />I'YC5 �'� OIIIIPIIIG � �� <br />Of pltK�l <br />IZ S�� LI�/IlJ4� pii�uflMG <br />4U _iL'1R�3Y`._ -- <br />P�cIMf�1i � Mtf�1�NIC111. <br />� � � f S '11�0 —� <br />--'— •PfN110N�1 fq�NO�lf.N <br />'_.___. Mllfll <br />SUBTOTAL E <br />PEi7MIT S <br />iOTALFEE E <br />rrr -I nrcnr� r�o <br />� r �r, i.5 <br />�iNff11111U1Nfi511RG1nlIf•F -'--- _ - <br />CITV OF EVERETT ronnr-wnn�s <br />IOCAL SALES -- - - - - --�- - -- �---- - - . . <br />TAX CODE IS 3105 TOTPL __ <br />FEE <br />T— <br />