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APPLICATI(� FOR C�I�iSTRUCT`ON PERMIi' <br />CITY OF EVERETT • BUIL'JING DIVISION <br />3200 CEDAR STREET • EVERETf, WA 98201 • 259-8810 EYT <br />C� DEMOLITION /� COMBINATION �gu�LDING �MECHANICAL �UMBING [I SIGN <br />PROJECT ADDRESS: �I/� � �"'� t,� c� - <br />�� I S�� .,.,....., a�. z�r �--- r��oNc <br />t'� ,�v� �t�rz>Fs� r[� �T �27o C�) 35 f <br />1EN/.N1 ...�........... _. _ _ <br />r�� PI�ONE <br />��� �NONF <br />l�� �nONE Slnl[ �ICENSE • <br />MECIUNICA� •�ONwiMy��►10f1 M�II �DORE55 f:ITY )iP PIIONE $1�IE LICFNSE � <br />S�� ( tT . <br />oescniee <br />vnal6seo use or auaar+a — <br />�or <br />or rno�nn iseqwn e[icw qn <br />_ aiocK or_ <br />AI�.J �/�K,W cc <br />PMCEI TIUf I D. NUMBER -- <br />Cp15IRVCiION IO�N IEN�EII, �U011E55. TELEPNONE NUMBEfI <br />NO. TYPE OF <br />Z WATER CLOSET <br />BATHTUB <br />L LAVATOHY(WASI <br />KITCHEN SINK 8 <br />UUNDiiV TRAY <br />CLOTHES WASHF.R <br />URINAL <br />FOUNTAIN <br />BACKFLOW PREVENiE <br />SINK (SEFVICE — OAR, <br />OR ITEM <br />c <br />GfY IIP <br />I HEATING SYSTEM: J <br />�� f,ONi�CiPE1150N�NOFMpHENO <br />���ONE ST��EUCFNSE� <br />❑ ELEC7RIC ❑ <br />�pG�_�J''S�) I D �" • <br />I HEREDV CERTIFY THAT I HAVE HEAD AND E%AMINED THIS <br />APPLICA�ION AND KNOW THE SAME TO BE THUE AND CORRECT ALL <br />PRCi; �SI'���S OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOf1K WI� 9E COMPLIED WITH WHETHER ,^�PECIFIED HEREIN OF <br />NOT THE GRANTIN6 OF A PERMIT DOES NOT pRESUME TO GIVF. <br />AUTHORITY TO �/IOLATE OR CANCEL THE PROVISION OF AN': <br />OThIFH STATE OR LOCAL LAW qEOULATINO CONSTFlUCTION OR ; f I�� <br />PE MANCE OF ONSTHUCTION. THAT I AM AUTHORIZED BY TI�E <br />0 !E O THIS P PERTV TO PERFORM THE WO�K FOR WHICH <br />AP UC T N IS AD AND I COMPLV WITN THE STATE <br />C TR T S LA 18. C AND 296,200 WAC. <br />K -- Ib/I S��l <br />C�tY BUSME55l�CFNS[ No <br />FEE I NO. <br />SUB TOTAL f _i <br />PERMIT f <br />TOTAI FEE S � <br />FOR OFFICE USE ONLY: <br />fRONISETp�Ch RE�I15 IB�CM <br />l� � �� � <br />usEidl� _ lolenEn <br />I�EIG��1 UMrt�IiON / NO OF DWEILING <br />7 UNitS <br />OCLUPANLY Iq M SIOm(5 OCCUP�NI We0 <br />i1RE �WIIM <br />,� <br />11F�SON <br />SIDESFTB� / <br />VACANI SIIF <br />❑YES ❑ NO <br />EpUIPMENT <br />rva.—iYnnuw Vnns <br />FORCEO AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHESDRVERS <br />RANGEHOOD <br />GAS RANGE <br />GAS PIPING <br />SUBTOTAL f <br />PERMIT f <br />TOTALFEE S <br />PlANC11FCNNUMpfO fCf IIFf.FIPiNO <br />r, - . � �� ��',—���. <br />� 01111NNf• <br />Sue or eiuc: i <br />�E.�9 (o � S I $. f riuunwc <br />B� MENI � � MFCNANIL�I <br />OYES p�FO — <br />�Op1IlON�I �R�N GIlCM <br />O1��E11 <br />9�iF OW101N0 SUIIC1qf16E <br />CITVOPEVERETT runi¢wonKs <br />LOCALSALES <br />TAX CODE IS �105 toTnL <br />FEE <br />—,-- <br />0 <br />0 <br />%. <br />