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APPLICATIL.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•BB10 <br /> ❑ DEMOUTION ❑ COMBINATION p BUILDIN4 �1 MECHANICAL ❑ PLUMBIN(i ❑ SION <br /> PHOJECT ADDRESS: <br /> .S�tve G/a��I1 .yY?914I�.n/C R�/. F✓�:t� `•'t'J:.7 1f5- J>'76 <br /> ONMER 4Nl�Dd1E55 CITY I�P PNON[ <br /> TENNIT MNL 11pdIC55 LITV zIP p�ppE <br /> ML/IITCGTOROESIONER 4�IlMOf1E55 �ITY 7i1+ PNONF <br /> OEMEMICONTRAtTOR M4lMppE55 f.ItY )IP P��ONE SIQEIILFNSE• <br /> MECNIUMCALCONTRILTOR MNlADd1E55 'ITY 7R` �IIONE SiAfFUCENSE• <br /> .T�irnw� f'.u.��J %f17 �+/�!� {���N /�/ ���.� i:Gl.l /qi JC"1 dYYu 7��..«� +'ue> �� <br /> AU4lWOCpNIRi1CTOR N�ILAWPE55 Lltv f"` PHONE STAIELILFNSE� p' <br /> cwra�cT w�c[a wo� — �_/-7 7 <br /> 3voo �,a HEATINGSYSTEM: ,C�OAS ❑ELECTRIC p <br /> OElCME NOIIM 11W SqIM1E f007110E W VOIVED CONTACi VERSON ANO PIqNE NO <br /> � ..� ♦// ✓ n.. ..,./ �i./ t.�,./ri �...�1/.� .�.f/� r .. if�se <br /> _ =NI�AI� ���0 f <br /> • I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> ' �p�a�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINO TIN6 TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> . �caNaexavnoaawavEnTr�s�awHeeiowon�rt�cHnvoconEs� NpT. THE ORANTINO OF A PERMIT OOES NOT PRESUME TO (IIVE <br /> � ior eiacM a AUTHORITV TO VIOLATE OH CANCEL �HE PROViSION OF ANY <br /> ; OTHER STATE OR LOCAL LAW REODUTINO CON$TqUCT10N OR iNE <br /> PERFORMANCE OF CONSiRUCT10N.THAT I AAA AUTNORRED BY T/IE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOqK FOq YMNCII <br /> APPLICATION IS MAOE AND I COMPLV WITN THE BTATE <br /> �Tµi,p_M�p CONTRACTORS LAW iB27 RCW AND 298.200 WAC. <br /> C0IMTINIC110NLON1lEN0ER.11Dp1E5S.TELERqqE MI�NER X ��y/, �[ /�,�,,�,� �/- �f%5 91 <br /> �AtUf1E -7 O�TE <br /> CITV&lSINESS IICENSC tq <br /> �L�M�MO MECHANICAL <br /> N0. TYK Of FlXTIME OII ITEM FEE NO. TI�E OF EO{IMMf/f� RE <br /> WATER CIOSET(TOILEn � A/C—NHNDLO UNRS � <br /> BATHTU9 ' FORCED AIR SYSTEMS ' <br /> LAVAIORY(VUASH BASIN) � HEAT PUMP � <br /> BHOMIER ' UNIT HEATERS � <br /> KRCHEN 81NI(i OISP � CLOTHES�RVERS ; <br /> 01811WA8HER � RAN6E HOC�D � <br /> IAUNDRY TRAV � WA1ER HEAIER � <br /> CLOiHES WASHER � WOOD STOVE � <br /> UHNVAL � MEfAL FIREPIACE(WOOD BURNINO) � <br /> ORMIKMJ(i FOUNTAIN � FIREPLACE INSERT(WOOD BURNINO) � <br /> FLOOR ORAIN � f1AS flFEPLACE � <br /> BACKROW PREVENTERS ; (iAS RANGE ; <br /> SMM((BERVICE—BAR.ETC.) � OAS P�P1t�G � <br /> ' IXHAUST FAN ' <br /> i i <br /> i � <br /> i i <br /> � � ��, <br /> � � <br /> SUB TOTAL t ' SUB iOTAI f ' <br /> PERMIT f � PERMIT f � <br /> TOTALfEE f � TOTAIFEE f ' — <br /> Fon o�ce use oN�r: <br /> i110p�9ETOK.II REMSFTd1CK &OESFTB�L1t PI�NCIIEtI(NU4BfR fFF HFCFM'fN0 <br /> us¢iaf iotu�� wcu�rs�re FEES VALUATION FEE <br /> Or[s o ra e�7irnNr <br /> N[ant uwiuraN ra a owewra suE or eioorti � <br /> 1M/11S PlU4BING i <br /> � <br /> OCCUPANCY Iq p SIMES OGCWANI lp�D B�SEMENT MECNiV11C�1 � <br /> OROUP � <br /> ❑YES ❑NO — ' � <br /> FIRESPWNI(LERREOD NF�SON — �DDiIION�LPI�NL�rtGM � <br /> 3 — <br /> on�en � <br /> I <br /> fYIEMMMHEO'D AE�c;1H <br /> SI�iE BUII�ING Silflf.rUp(iE i <br /> _' �� <br /> nv[orr.or+sr PIANSMIWOVED BV CITV OF EVERE7T �IIpUC WOpKS � - <br /> LOCAL SALEB -- —i-- <br /> o•re TAX CODE IS 9105 TOTAL I <br />