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APPLICATIO . FOR CONSTRUCT'�1N PERMIT � <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> ❑ DEMOLITION p COMBIN�Al ION /J�❑ BUILDINd p MECMANICAL ❑ PLUAABING ❑ SIGN <br /> PROJECT ADDRESS: �ja 3 (�'/,I�U`��-� <br /> JMMEN NMl�Wf1E54 Qtt tiP p11pNE <br /> SnME► Zu�EcA ya3 q���rs�,� B�Ja, f���r-,�- `/82ui ��o�) zr-y-[���I� <br /> 7FNI1N7 YMIM)WIL55 CIIY )IP PI�ONE <br /> •qLHIT[�TOi101iSIONER MM111D011E55 CIfY )11' PMONE <br /> OENEMIGONfO�CIOR NA1lIWDRE55 PIY I�P PIIpNE SI�TEUCFNSE• <br /> MECNAMCQCOVTRI1L1011 MAIL�DDNE55 LITY IiP P110NE ST�iELI�ENSE� <br /> MUhMMqCONiR�CTOR MML�Dp1E55 CItY 2iP PNONE SMTELICENSE� <br /> pAJES S£KJiL� ('� u.v�B i�1� EJE�Lc�T DAJFSS P Ilo SJ'8 <br /> Cp11fuGT VPoLE OF Wq1M <br /> HEATING SYSTEM: �OAS ❑ELECTRIC ❑ <br /> OESCRDE WOf11(�ND SOII�RE f00Th6E INVOlVEO CON1�Li PCRSON�NO PIIONE NO <br /> J <br /> « ,�� I HEHEBY CERTIFV THAT I HAVE FEAD AND EXAMINED TH�S <br /> rnorouo use or au�dra APPLICATION AN01(NOW THE SAME TO BE THUE AND CORRECT ALL <br /> PHOVISIONS OF UWS AND ORDINANCES 60VERNIN6 iNIS TVPE OF <br /> WORK WILL BE COMPIIED WI7H NM1IETHER SPECIFIED HEREIN OR <br /> uauotscnvrronarnovcan�s�ar+ne¢�owaa�n�cv.iwocones� NOT. THE OiiANTINCi OF A PEAMIT DOES NOT PRESUME TO 61VE <br /> ioT eiocK a AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY <br /> 01NER STATE OR LOCAL LAW RE6UI.ATIN6 CONSTRUCTION OR TME <br /> PERFOfiMANCE OF CONSTRUCiION.THAT I AM AUTHORIZED BY TME <br /> —� OWNER OF THIS 1'ROPERTV TO PEHFORM THE WORK FOR WHICH <br /> APPIICATION IS MAUE AND I COMPLV WITN THE BTATE <br /> M110EL TiUI I O NUMER CONTRACTORS LAW 1B.t7 NCW AND 2Y6.200 WAC. <br /> CON6111UCTION IOIN LENOER.�0011E5S.TElER10NE NUMlER ��yy�� C�.fArWJ�.. /D`p� "J�4 <br /> ATUt1E 7 D�TE <br /> GT�lUSINESS L1LEN5[NO <br /> �LUIIMq6 MECHANICAL <br /> NO. T1hE OF FlXTUIIE OR ITEM FEE NO. TYr!OF EplI�MENT FEE <br /> WATER CIOSET(TOILET) � A/C—AMNpLa UNITB � <br /> BATNTUB ' FORCED AIR SVSTEMS ' <br /> UVATOi1Y(WASH BASIN) � HEAT PUMP � <br /> SMOWER ' UNIT HEATERS ' <br /> KITCHEN SINK i DISP i CLOiNE3 DRYERS i <br /> DISNWASHER � RAN6E HOOD i <br /> LAUN�RV TRAV ; WATER HEATER ; <br /> CLOiNE3 WASNER � WOOD STOVE � <br /> URINAI ' MEfAL FIREPUCE(1NOOD BURNINO) ' <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSENT(WOOD BURNIN6) � <br /> FLOOR DFAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; OASRANOE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPINO � <br /> ' EXHAUST FAN ' <br /> � <br /> , � <br /> SUB TOTAL f ' SUB TOTAL f <br /> PERMIT f � PENMIT f � <br /> TOTAL FEE f ' TOTAL FEE t ' <br /> FOR OFFICE USE ONLY: <br /> i11pITlETl�CAf PEM6ETMCN SIDEBETl�Ck Pl�NL1iFGMNUMNfR iEF RFf.FIPINO <br /> ~3�/ <br /> usEta�[ tot�n¢� v�cu/rar¢ FEES VAlUAT10N FEE <br /> OYES ❑ � oUno�Na <br /> NEIOMTUWUt10N NOOiDWELUNO SISEOilLOO/U � <br /> . UNIf$ P�pMBINO <br /> ��� <br /> OCCU/�IICr 1q Of f�M[3 OCCUP�NI IO�D l�SEMENI MFLN�NIf.�I � <br /> OMIlP <br /> ❑YFS O NO � <br /> fNiEBPRINKIERREO'D �E�SON �DO��ION�L�l�NC11fCN i _ <br /> i <br /> on�cn , <br /> FUIEMARMXEO'0 NF�Rp+ ' � <br /> SfAIE OUIlOIN6 SIIf1CIq00E i <br /> trve ov r.oasr PUNS MPPOVEO BY CITY OF EVERETT ruei ic vmnes <br /> LOCAL SALES '—'J— <br /> ���iE TAX CODE IS�f05 iOiAl � <br />