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ARPLICAT[^N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUIL.DING pIVISION � <br /> 3200 CEDAR STREET•EVERETT.WA 96201 •259-8810 '���" <br /> ❑ DEMOLITW�N ❑ COMBINATION ❑ BUILDINO �� MECHANICAL �PLUMBINO ❑ 810N <br /> MIOJECT ADIIREBS: <br /> M4llIWAE59 CITY I�P PIqNE <br /> �,(��-�� Fotie�n-I �aa, A��( F�Sc�I G�I-�.RZo�I ZSq �h�-3o <br /> 1 �.uneod�[ss utr 7�a raHe <br /> MCNIECfd10E51ffNER IWI�DOAE��� GTY 7in P110NF <br /> ��pNTp�fpl Il�Wi1E55 CIT�� .11r P1qN SGTEIp FNSF� <br /> :���� � �,� $�G1- TI;��Yk� ��cU�aqk'1�19 nldr�.'ft4u1Hlo3R,Z <br /> YCpITihCT R WK 55 � —�Air � �� PIIONE� � -.�fEL10EN5F� <br /> �n`y'-:.s Z �-o a <br /> RIMMO�'ANTR/CTOR � Y�ILIIODRE LI�Y IIP PIqNE STATE IIGENSE� <br /> °°"nuct'"�°f 2 .� HEAYIN(3 SVSTEM: �O�S ❑ ELECTRIC ❑_ <br /> o[�t�rawuosaw�roo w v[o CdIT/�CTVER40NANOP110NF.N0 �`1 r"jf� � <br /> �� � <br /> �� I HEHEBV CERTIFV THAT 1 HAVE REAO AND E%AMINED TMIB <br /> APPIICATION AND NNOW THE SAME TO BE Ti1UE AND CORRECT ALL <br /> �o ■�x�� pROVtSIONS OF UWS AND ORDINANCES 60YERNNN3 TlMB TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �axann�arnn[rm�dawne[�oww�n�cNiwoc�s� NOT. 7HE ORANiiNO OF A PERMIT DOEB NOT PREBUMIE TO 6IVE <br /> im _K� a AUTHORITV TO VIOLATE OR CANCEL THE PROVI610N OF ANY <br /> OTHER STATE OR LOCAL LAW HEQULATINO CONSTRUC110N OR THE <br /> PERFORMANCE OF CON8TRUCTION.THAT I AM AUTNORIZED BV TIIE <br /> OWNER OF TNIS TO THE WOtM( fdl MIlMOM <br /> APPLICATION MAD AND I C PLY WITH THE BTATE <br /> �wicunucTO.�w[�� CONTHACT U AND 200WAC. _ <br /> ownucnw iaw��«ocfl�oonc:e.reiena�M�n ( <br /> 610N�T TE <br /> CITV PVSYIE59lN:ENSE NO <br /> /LI�10 MECNMMCAL _ <br /> MD. TII�E OF fORUII!OII REY FEE N0. TYrE OR ECIlNNfIIT RE <br /> WATEii CLOSET(TOILEn ' NC—MiNOLO UNRB ' <br /> ���g ' FORCED AIR SYSTEMS ' <br /> IAVAtttRV ryYA6H BASIN) � HEAT PUMP � <br /> �E•q � UNIT HEATERS ' <br /> KRCMEN SMrK�qSP � CLOTHE&ORYERS � <br /> q&NYA411ER r RAN6E HOOD ' <br /> LMJNOR'f TMV i WATER NEATER i <br /> CLOTIIE6'WASHER � WOOD STOVE � <br /> �� � METAL FIHEPIACE(VVOOD BURNIN6) ' <br /> ppp�l(Nq FOUNTAMI i FIREPLACE INSEFlT(WOOD BUHNINO) � <br /> ROOA DRIUN � (iAS FIREPIACE ' <br /> BACKFLOW PREVENTERS ; GAS RAN6E � <br /> 8WK(8E Il'.E—BAR,ETC.) � C3AS PIPING ' <br /> � IXHAUST FAN � <br /> � <br /> � <br /> � <br /> � ; <br /> � <br /> � ' <br /> SUBTOTAL f ; SUBTOTAL t ' <br /> PERMIT f � PERMIT f � <br /> TOTALFEE f ' TOTALFEE f ' <br /> F�n o�ce use oN�r: — <br /> f110YTlIEidICN REMSF.TIMCK S�OESFi&1LM PlMlCIIEGKNUMflFfI (fF Rff.ElPflq <br /> us¢iart ior ur� wcu+r s�t¢ FEES VAlUAT10N FEE <br /> ❑YFS O� BIIIIDIN(i � <br /> N[a��r u�urarr �,o a owewno s�zE a e�onni ' <br /> � <br /> ur1rts vwuen+a -- _ 1 <br /> � <br /> OLCIMANLY MO Of SI[1qE5 OGCW�NI 10�0 B�SE4ENf 4FCNu11C�1 � <br /> G11dIP � <br /> ❑YFS O NO � <br /> flkElH�INIfLERREO'D HF�SON �DM�ION�IR�NC11(GM _ <br /> � <br /> O�NER i <br /> FIqEAIARGFEO'D RE�c(iN�—"-- i <br /> SI�IE BUIlDIN6 SU11CH��GF � <br /> rrre tr r.a�s'. ri e�i!'i.Ti��cJi�;t�v CR'f OF EVERETT ruanr.wcmns _�_ <br /> LOCALSALES ' <br /> _ ��rt__ �TAX CODE IS 7105 TOTAL ' <br />