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APPLICATIf-`Y FOR CONSTRUC'i`�DN PERNi1T <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COpMBINAnTIO_N 17CBUILDING ❑ MIECMANICAL ❑ PLUMBING O SIGN <br /> PROJECTADDRESS: /�17�7C.lJ��j�/ <br /> /.; .. �skor<.�� �o�a s-z� 7 � -, - � <br /> �'f� y� � .� r, s� -9.�s�� <br /> �E MMLAOp1E5 cm nr rnpaE I <br /> ,��,v��- �i���L ) muin�� ,�n�� <br /> TEN�NT • MqL/QlORC55 GTV )iP P��ONE <br /> P�f��c l, � N�SG,� /-��r� ` �-�..��� ,zs�'�'6� <br /> AnLMTCGTOROESiGNER MAIll�U0P�5 CItY 7m PHpNE <br /> Ar.�f- r�;�i/�lI'L 6,o%�o,rs u� 7 �.x..p/rL u;4.. ��r� s��s� <br /> G NEIU(CONTB�CTOR MAI�/�pDRE55 CIIY lIP PIIONE $IeIELICFNSE� <br /> MELNIINIC0.CONTRACTON MNLA�DRES$ CItY ZIP P11pNE SiAfEUCENSE� <br /> PIUMEMGCONTRA�T0f1 MNL�DDRE55 qfY ZIP PHOHE $TATELICENSE� <br /> CONTMCTPf11GE Wp{iK <br /> �cQ -"' HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> OE IEEWJq1(�NDSOUAREFOpTAGE1NVp�VED LONTA�TPERSONANDPHONENO <br /> A�2rFh� Ri_ F�i� �,.��Oi-.0 <br /> � P.+�� t <br /> I HEHEDV CER?IFY THAT I HAVE READ AND EXAM�NEO THIS <br /> VROPOSED USE OFlU1LqN0 APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> ��,,,��� PROVISIONS OF LAWS AND OROiNANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�L0E5CPoPTIOHpFP11pPEpTY�$�qWqg(�OWOqATiAGMTWpCOFIES� N07. THE GRANTING OF A PERMIT DOFS NOT PRESUME TO GIVE <br /> �oT e�ceK oa N.�THORITY TO VIOLATE OH CANCEL THE PROVISIqN OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PAfILEI TM I.D.MIMBEP CONTRACTORS LAW 18.27 W AN�D 2J96.200 WAC. <br /> CONSTRUCTIONtfOI�HIENDEP.M/q/���55/.J��,LEP110NENUMBER x11Z%�'^����i:��LtXR� /� � � "" I <br /> _ o�CB�� `�'��/ ✓y SIGNATIIAE �� <br /> D�fE <br /> CITY BUSINESS UC[NSC NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF Fll(TURE OR ITEM FEE NO. TYpF.OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—MiNDLG UNITS � <br /> BATHTUB ; FORCEO AIR SYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> DISHWASHEH � RANGE HOOD � <br /> UUNORY TPAV � WATEF HFATER � <br /> CIOTHES WASHER � WOODSTOVE � <br /> URINAL � METAL FIREPIACE(WOOD BURNING) � <br /> DRINKIN6 FOUNTAIN ; FIREPLACE INSERT(WOOD BURNIf�G) ; <br /> ROOR DRAIN � GAS FIREPUCE � <br /> BACKFLOW PREVENTERS � GAS RANGE ' <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> ' EXHAUST FAN � <br /> � , <br /> � , <br /> � , <br /> SUB TOTAL S ; SI�B TOTAI f ' <br /> � PERM�T S � PERMIT f � <br /> TOTAI FEE f � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: J03 t�� <br /> FRONTSETBAGR RE�RSETB�CN � SIOESETB�Ck PIANC�NNUA1Pff1�� fEf_���/ OCf.EIPTNO <br /> ' G <br /> usEior�e tOten¢n VA��Ni51fE FEES VALUATION FEE <br /> pres ❑�a nwinn+r. (,ft� S OD C � � � <br /> 11EIGIR LIMITATION NO Of OWELL�NG SIIE Oi BLUGq I <br /> UNIiG P1111AliINC 1 <br /> OCCUPANGY Np ptStOW(5 OCCUPANTLO�D B�SEMENT T <br /> GR P MfC11�NICM <br /> 1 <br /> N9 s a� o�� 7�' 9 <br /> FIRESPOfJKIERRE�'D f1FA5Q4 ��D�71ANN PUNCuf.GK <br /> �^S �J� S'�� i <br /> otum � <br /> fIREAIAflMREO'0 PEeCpN / <br /> �� �X S r� ST�1E011i1[uNG511f1G1UtiGE -- lJ i ��'� <br /> __L � " <br /> TYPEOGCONSf rinNsenrn vEper CITYOFEVERETT rumir.wonKs � <br /> // f _ I �lp �Aj LOCALSALES — — --'— <br /> � 7�� u.rE L - Z - q TAX CODE IS�105 To7A� �:l'� ; ?� ; <br />