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APPLICATIQ"' FOR CONSTRUCT: 1N PERMIi <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAP. iTREET • EVERETT, WA 88201 • 259•8810 <br />❑ DEIYIOLITION ❑ COMBINATION j�BUILDIN(i ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRE5S: �a s"��7 ' S� S� <br />pwr+Ea ) / uu��ooness cin �/� rm rr�S. <br />�.,...i�/'L....�J �0..�,n l�.�PrC/7 9� l <br />i.ncM�tcra+oesmr+ea M�It�WRE55 c�n �m war�F <br />PLU4BHOCONTR�Cfp1 YML�OORESS CIfY SIP PUGHE SUfEIItENSE� <br />cwTw�cr <br />OES�RIBE NO�N �NO <br />T'�r <br />�m <br />BIOCN <br />(&qWN <br />PARCEL LV! I.o.�9i(1 O OO O O�/� `/` <br />jyd -r o <br />CpN511111CTION IOM/ LENOEN. �OO�E55. tELER10NE MIMBER <br />NO. TYPE OF Fl%TUI <br />WATEH CLOSET (TOILE' <br />BATHTUB <br />IAVATORV (WASFI BASII <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER _ <br />UUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTE <br />SINN fSERVICE — BAR, <br />C01ME5� <br />SUB TOTAL S <br />PERMIT S � <br />�— TOTAL FEE E I ' <br />FOR OFFICE USE ONLY: <br />IIIpHt 6ETRACN RE�R SF.TB�CN SiDE SETBI�CM <br />USE 20ME lOf �REA V�C�Nf S�IE <br />❑�ES ❑ ND <br />HEIOItlUMIUTION NUON,OfDWELLINO SIIEOIBIDOrtI <br />MJ p <br />P.1 <br />PF�GOH <br />n�it <br />❑YFS ❑ NA <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 7105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />cor�t�c�r[nsor��rmr e�+o <br />/'�., Ro� tit�" 3s3 -� 3� y <br />I HEHEBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COfiRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TVPE OF <br />WOHK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORAN11N0 OF A PERMIT OOES NOT PRESUME TO �iIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REODUITINU CANSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PHOPEATY TO PEAFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS L 1� 7 HCW AND 286200 WAC. <br />J[ �-h�i ��l.r ��" �— � �/ � — <br />S16N�NPE O�TE <br />CIiY BUSiNE55 LICENSE NO <br />NECMANICAL <br />NO. TYPE OF <br />NC — AMNDLO UI <br />FORCED AIR SYS7 <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERf <br />RANGEHOOD <br />WATEH HEATER <br />WOOD STOVE <br />METALFIREPLACE <br />FIREPLACEINSERI <br />GAS FIREPLP.CE <br />GAS RANCaE <br />f9 �N f IIf.CK MUMBf Il <br />OU�I OiNO <br />1`111M01N(i <br />MFC1UNIf.�I <br />�DO�IION�1. Pl �N C��f CM <br />ov�rn <br />SUIF BURLIH(i S.I�CMO6E <br />PIIOI lf, W(N1F5 <br />TOTAL <br />SUBTOIAL S <br />PERMIT f <br />TOTALfEE f <br />rEF iJ / nrr.rm�No <br />'7� O <br />