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APPLICATIO�1 FOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVEHETT. WA 98201 •259-6810 <br /> rl DEMOLITION fl COMBINATION fl BUILDINO MECHANICAL � 1 pLUMBINfi f 1 SION <br /> PNWECT ADDREBS <br /> �zz A���,v ,��vv, <br /> OVMER MM1�0011ESS {,ITY ZiP P�NE <br /> �oE (�.?EfNLEg� ,3_'2 AcvC�� cl�D, r✓£�'Ei7' /�370� .ZS`i— ,3Y9G <br /> TEN�NT Y�IL�OORF.55 f.l7Y zlP PIIONE <br /> �RCMTECIORDESi6NER M11��DORE55 CITY 7tP PnONF <br /> OENEMLCONTf1�CTOq M�Il�0ORE55 CIIY Z�P P�IONC $LALCUCCNSC� <br /> ME/C�NAN�IC�LCONTRIICTOR M�I��DDRE55 CITV 21{+ P110NE STUELICENSE� <br /> C 3s <br /> MUMlIN6CLNTRM:TOR M�Il�00NE5¢ CItV IIP PNONE ST�TEUCENSE� <br /> ��C t T PfMCE OF <br /> 2�p.� HEATIN(i SYSTEM: i OAS �l ELECTRIC fl <br /> OESCPoSE WONN�ND SOU�RE f00T/�6E 1NVOLVEO CONTIICT VERSONAND VNONE N0 � �C <br /> INSTa� A /ZS,Oco B?al �/�►7ZaF'A ZS�-.51/'� � <br /> �U�1//�'E, //L<J T/va � ��'/ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> s�����d� — APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br /> LE611LOESLMPTIONOiP110PERiYISNOWNlEIOWOR�TTALNTW000iIE5� NpT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO dIVE <br /> iot s�acK or _ AUTHORITV TO VIO�ATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATINU CONSTRUCiION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUtHOqIZED BV THE <br /> OWNER OF THIS PROPEF?V TO PERFORM iHE WORK FOR WHICH <br /> APPLICAI'ION IS MADE AND I COMPLV WITH THE STATE <br /> RIRLEL tlUt IA.NIMAlER CONTRACTORS LAW 1827 HCW AND 298200 WAC. <br /> CONSTNUC710N IO�N lENOER.l1DDnF.59.TElEP110NE NUMEER �� S. �� /Z�7�� <br /> 510 tU U�TE <br /> CITY BUS�NE55 LICENSE NO <br /> rLINNINO MECNANICAL <br /> N0. ?hE OF i11fi1M!OII ITEM FEE NO. TYR OR[qN/IiNlf� iEE ' <br /> WAtEHCLOSEi(TOILET) � IVC—AMNDLOUNR9—H.P. � <br /> BATMTUB ' FORCED AIR SV9TEMS—B.7.U. M E.A. j <br /> LAVATORY(WASH BA61N) i NF�T PUMP � <br /> 6HOWER � � UNIT HEAIERS—B.7.U. M ' <br /> KITCHEN SINK 6 DISP i CLOTHES DRYERS i <br /> OISNWASMER � VENTILATION FAN � <br /> � LAUNDRVTRAV ; RANdEHOOU ; <br /> CLOTHES WASHER � WATER HEATER � <br /> URINAL ' WOOD STOVE ' <br /> ORINKINf3 FOUNTAIN � METAL FIFEPLACE(WOOD BURNINO) i <br /> FLCOR DRAIN � FIREPLACE INSERT(WOOD BURNIN6) � <br /> BACKFLOW PREVENTERS ; DAS FIPEPLACE ; <br /> SfNK(SERVICE—BAR,ETC.) � OAS RANOE � <br /> ' OAS PIPINO ' <br /> � EXHAUSTFAN � <br /> � � <br /> i � <br /> SUB TOTAL f ' SUB TOTAL S O ' <br /> PERMIT f � PERMIT f / � <br /> TOTALFEE S ' TOTALFEE f ' <br /> Fon oFflce use oN�r: <br /> iRdlTtSETlIACI( REMSFTB�CN SIDESETB/�Ck VUNLNECRNUMBFII fEF RFCFIPTNO <br /> SZ�d.�� <br /> usetor� IOT�RE� V�C�N151IE FEEB VAWATION FEE <br /> ��ves r i No aunnn+c � <br /> /IEIONTUIMi�TION NOOFOWELLINO 512EOiBlOGRI � <br /> UNIiF P�UMBINO { <br /> Q�NCY Iq Of 51(NpFS OCCUP�NT LO�O B�SEMENT MECII�NICAI � <br /> IIYES II NO � <br /> �DfNIIf�NM.PI�N CNf.CN � <br /> FIREAIMMR[OD NF�SON i <br /> O1NER � — <br /> i <br /> FIpESPRIN1tIERREOD RF�SON i <br /> SI�IE PUIL�MO SUHf:1URGE � <br /> IYPEO�f,ONSf Pl�NSM'PROVEOBv CITYOFEVERETT runur.wonKs � <br /> LOCAL SALES --- '— <br /> u�rE TAX CODE IS 3105 TOTAL � <br />