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APP6.ICAT1( ! FOR CONSTRIDCT 7N PERMIT �}�. <br />CITY Of FV[RETT • DUILOING DIVISION �/� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•BB10 �C <br />❑ DEMOLITION y�-COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: '� S � s i. �E _ --r `I8 Z03 - '+�'''1 �� � � �" � <br />� vv -- �>. L 3 ss - z�f z'�- <br />owHEn ueii •ooness � '/ c/yrv �y� �J rr�o��¢ <br />u�JOC('�,rP�efl• `?.�%'/ %1G^y�,/�Vc' vf ,/YQ.L��llYtf_;/.3�1�i� <br />1EN�N7 ��Il�b0�C55 f.IIY 7iP PUONE <br />•nC111TCGT OIl DES�GHER M�It ��fIDE55 GIY liP PNONF <br />GENE��I WNIML10f1 M�VI �IXIRF55 CIIY JIP P110NE ilAfC IICCNSE � <br />MECIUMC�l�ON111�CTlifl MAII�WRE55 CI`�A.T,,� QAIYIO � 7i� / PIIONE S1��El�GtNSt� <br />, Ci) � b1 <br />PLVA�BIN6CON(RAGiOR MAIIADORE55 QtY rIP PIIONE SUIELICENEc� <br />GONfRACI PNCE 0� M/O/f�'R /� <br />��l G �C� <br />DESCRIBE NVIIN 1N0 SOU��E FOO7AGE �NVOlVEO <br />F�rtF R FP�a�e ro npPaT <br />l� os ��y b,z� <br />�i-r � � � orLC - M� S. `7R <br />vnov�oseo use cu euionm <br />,�F/J'T.GL_ /9//9� <br />iee�� oEumrna+a rnorEntt �s�wwr� etiow <br />ior maK or_ <br />CONSTRVLTIdI IONI lENOER AODRE55. TELEMp1E NUMPFR <br />WATER C <br />BATHTUB <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />UUNDRV TfiAY <br />URINAL <br />DRINKING FOUNTAIN <br />SINK (SERVICE — BAR, <br />Oii ITEM <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />ff10Nf SETO�CK �E�� SFIB�Lk <br />i15EIONE lUl�nE� <br />im�mn uun•nor+ r+o or ow[uwr, <br />ur+rts <br />OCCUPANCY NOfx SIOafS OCLUP�Ntl0�0 <br />GnOIIP <br />RE�[pN <br />or <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />f.ONI�GI Pf1150N �NO VIIONE NO , � <br />�f1ERE0Y CERTIFV THAT 1 HAVE HEAD AND E%AMINEU THIS <br />F'FLICATION AND NNOW TNE SAME TO BE THUE AND CORRECT AI.L <br />PflOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GPANTING OF A PERMIT DOES NO� PRESUAIE TO GIVE <br />AUTFIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW HEGULATINd CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOfl WHICH <br />APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 HCW AN� 296200 WAC. <br />CIiY BUSMF55 UCBNSC NO <br />FEE NO. TYPE OF EOU <br />A/C — MiNDLG UNRS <br />; FORCED AIR SYSTEMS <br />HEAT PUMP <br />' UN17 HEATERS <br />CLOTMES DRVERS <br />RANGFh'OOD <br />� WATER HEATEfi <br />i WOOD STOVE <br />—'-- <br />� METAL FIREPIACE (WCI <br />, FIFiEPLACE INSERT M/O <br />GAS PIPING <br />E%HAUST FAN <br />5�DE5Ere�cK r�e��cn[cnHuunrn <br />` '' ♦ � <br />�! �/ <br />V�CeNI SifF PEES <br />❑r[s ❑ �o nunnwn <br />s¢e or eu�nn i ----- <br />riuumNa <br />B�SFNENT Mfl:�lu�lC�l <br />❑Y[5—� NO — <br />•flblllOH�l PI�NCIIlf:N <br />ow[n <br />$I111C p1111UM6SIIfIC1Uf10E <br />CITY OF EVERETT runnr. wnn.s <br />LOCALSALES — <br />TAX CODE IS J105 70U�L <br />���c <br />FEE <br />SUO TOTAL f ; <br />PERMIT f �— <br />TOTAL FEE f ' <br />rtr nrr.emrNo <br />VALl1�T10N FEE __ <br />2��� ' <br />2n�'no � <br />