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APPLICATION FOR COr'iaTRUCT�Ot� PERM�T� <br /> CITV OF EVERETT•BUILDINO DIVISION <br /> 3200 CEDAR STREET•EVERETT.WA 99201 •259•8810 <br /> ❑ DEMOlIT10N ��COMBINATION ❑ BUIlDINO C] MECHANICAL O PLUMBINO U SIGN <br /> PROJECT ADDRESS: �� 7 � ���/Ye� � <br /> ►3a¢SEYi-I G�1-1'STf2Ul.Tloo-I ��L I?�- ��'A"�'� f�.V� MPIzY�'Vll�l?E�Iv'���,7 _ <br /> pNMFR 4ML�OOf1ES5 CITY i1P PHOrvE <br /> TENY1i �.AL10IX1E55 GTY/ 21P V��ONE <br /> T�� �flrzs��-4-1 ��� / �� - �0 34� <br /> �NCM�Ec70RDE516NER 4NlMORE55 -- CiTVC ZIP rHONE . �Dld�j/G�, <br /> �ar� �i"t-a �n*-�ST2�-IG?'Ia+--I i�--1�� Sf„�.S 13o2s�Ll0'77MIz <br /> OEMlMI COMTIYCid1 NYLMDRE55 C�TY ZIP P��ONE &IATE LICENSE 'z�I���� <br /> �� G ►-�5°�T1t�IGi �6�E�r v:�/s� �i4�--7�1�1 JcHL.+'�IE�OSSR.� <br /> MECN�HiCaL CONTMC70R M/ul�DDRESS CITY � ZIG PIIONE ST�TE ULEMSE� <br /> �r-r� }7LUI.n13i�-1L� 5 -���InMiSN vNA ��P�4237 �Ozl�7'11Z.� i3u <br /> MU CONTPACiOR MAIt�DORE54 Cltt � IW PHONE STATELILENSE• <br /> ��7�� <br /> tONTR"CTP"�0"VORN HEATING SYSTEM: GAS O ELECTRIC ❑ <br /> 5 hI W �0..1�S t' <br /> OESLRIlEM/ORIfA105W�ME WOiKiE WVOLVE4 CONT�CTFE113fXlNIDPNONENO <br /> ,� — ro�n v�arLs�T� tv 4 <br /> I HEREBV CERTIFV 7HAT 1 NAVE READ AND-E)GUAINEO THIS <br /> APPLICATWN ANO KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnorosEousEosauxnux� PqpVIS10NS OF UWS AND OROINANCES GOVERNINO TWS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIfIEO HEREIN OR <br /> �c�pEuppnpJpap�qv¢mv�s�owNe¢�owpp�n�cNiwotoviesl NpT. THE OMNTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> �oT�_�� ' � AUTHORITY TO VIOLATE OR CANCEL THE PROV1810N OF ANY <br /> OTHER STATE OR LOCAI LAW REODUTINCi COMSTRUCTION OR THE <br /> p 1r I7Pd2/G5117 E �1�5 PERFORMANCE OF CONSTHUCTION.THAT 1 AM AUTHORIZEO BV THE <br /> OWN OF THIS PROPERTV TO PERFORM TH8 WORK FOR WHICH <br /> _ �O I�y � APP C ION I ADE ANC I COMPLY WITH THE STATE <br /> — CO S 1 27 RCW AND 298200 WAC. <br /> PNCEL TA%1.0.M1M9ER . <br /> GONSTRUGTION ldW lFNOER.AOOi1E55.TElEP110NE NUMBER X . <br /> E <br /> Cltt BU&NESS LICFNSC r+U —.. .... <br /> p��ya�p MECHANICAL <br /> Np. TrpE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIVMEIR FEE <br /> WATER CLOSET(TOILEn A!C—AMNDLG UNRS ' <br /> ��� � � FORCED IUR SYSTEMS � i <br /> UVATORY(WASH BASIN) HEAT PUMP � ' <br /> �yyEp � — UNIT HEATERS ' <br /> KRCHEN SINK 6 DISP . q.OTHES DRVERS � <br /> DISHWASHER RANGE HOOD ' <br /> LAUNORV TMY ' WATER HEATER i <br /> CIOTHES WASHER � � WOOD STOVE � <br /> UR�� � � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FWNTAIN .� FIREPLACE INSERT(WOOD BURNING) � <br /> � ROOR DRAIN GAS FIREPLACE ' <br /> — BACKFIOW PREVENTERS � -� ��Gt ' <br /> SINK(SERVICE—BAR.ETC.) OAS PIPING <br /> IXHAUST FAN <br /> i ' <br /> i � <br /> � <br /> SUB TOTAL S � SUB TOTAL S ' i <br /> PEHMIT f � PERMIT S � <br /> TOTALFEE f � TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FqpRgTg�ILK pE�p5ET9/1Ck SIDESFTB�CN PI/JlGNECNNUMBER FEF RELEIPTNO. <br /> � ' Zo ' S' �/l>C�;Y �� . <br /> � <br /> �EZp� �or• � v�cuV*si*e FEES VALUATION FEE <br /> �� I ��SU �'ES ❑NO BUIIDING ZBy / i � <br /> I <br /> IIEIGMT UMITIRION � MO Oi UVJELUNG 512E OF BL0�R I � �� <br /> UNIT$ �f7(� S.F �/Vihlli 'f' pl11MBIN6 � <br /> �� 1 Zo S.F. GAI¢A .5 <br /> pC�p11NCv Iq Of Sf(MIES OCCUPANT 10�0 B�SEMENi ,� � <br /> � MECH�NIG�I <br /> �3 'I JU � ❑vE5 O�0 i <br /> ♦DDITION�L PUN CHFCK � <br /> fIRESPRINKIERPEdD FF�SON - <br /> OTHER <br /> I <br /> FIREAIMMREO'D RE�Sq� � � <br /> STAIE 8UIl01NG SURCN�RGE �� <br /> rvvE or r,dast w nH5�ovaovEo ev j;�TY OF EVEREIT P1�B11f.WOi11(C ,�� <br /> _, / J F{ LOCALSALES — <br /> /v � o�rE 3 /9 TAX CODE IS 3105 TOTAL <br />