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APPLICATION FOR CONSTRUC7.ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEOAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION p COMBINATION �J BUIL[�IG ❑ IIIECHANICAL ❑ PLUMBING ❑ SIGN <br /> PRO`JECT A�DDR SS: � / %� � �G`d�� � �� <br /> �[YJot�' /G16r+.�A cn� . <br /> MNL�DOi1E55 �� dtt IIP PNONE <br /> �. Bo c� S612 �'c%�-cZ`� W,4. 9 BzaCo =;c� - z s� -�SSlo <br /> TENMIT uuIMOPE55 GTY 2�P ��E <br /> 6W f�..1 O l/� <br /> •RCM�ECTpIGES�GHEF M��l�0URE55 CIiY 71P ANONE <br /> owNe� - <br /> GENEf1AlCONTP�CTOR NULADDRF55 LITY 7�P M10NE SMiELICFNSE� <br /> Gw+uc c� <br /> MECNANICAI CONTR�CTOR MAIL�ODNE55 CITY IIP P��ONE STATE ULENSE� <br /> �C..V 1�.1� lJ� <br /> PLU4lkMCf�JTR�CTOR M�ILADORE55 CIfY 21P PNONE SiATELICENSE� <br /> Lp1TMLT%iILEOF WqiN HEATING SYSTEM: ❑GAS ❑ELECTRiC � <br /> pE$CpSEWV1IK�NDSOU�AEFOOiM�i jMVQ�/y�D Q ALT LNSONAN�PHONE <br /> iN�QI.�IO �w O ( �Z'OU$�R( �O_ Cl� t.� SORI <br /> Q. '� T oGK�S/ 0-�-,L <br /> 5'pw� �L..�p I�+..�t�' EGo ^L I�'�/�wd L I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnaro�o�oveuaawa f PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS riPE OF <br /> Cd c.«Qt�C � /4-L WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEMLOESLPoPTIONOFPROPERtt(SHOMT�BELOWORATTACII7WOl;OPIES� NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO 31VE <br /> iot e�ocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THA": .AM AUTHORIZED BV THE <br /> OWNER OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMIGEL LV!I.D.�,^.'NBER CONTRACTORu LAW 1827 RCW AND 296.200 WAC. <br /> ow rv Q � / '�3 "0� '� 9 -9-p � <br /> CpNSiplICT10N lWN LCNDER.�DDRESS.TELEP110NE MNBER x <br /> ATIIf1E DA1E <br /> Cltt BUSINESS IILENSE NO. <br /> PLUMSIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. T'PE OF ECUIPMENT FEE <br /> WATER CLO5ET(TOILET) � A/C—AMNDL6 UNfTS ' <br /> BATHTUB ; FORCED AIR SYSTEMS i <br /> UVATORV(WASH BASIN) � HEAT PUMP ' <br /> SMOWER � UNITHEATERS ' <br /> KITCHEN SINK 8 DISP � O CLOTHES ORVERS � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY � WATEH HFATER it�lOU � <br /> � <br /> CIOTHES WASHER � WOODSTOVE ' <br /> URINAL <br /> � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIRF.PLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BA:.KFLOW PREVENTERS i GAS RANGE � <br /> SIMK(SERVICE—BAR,ETC.) GAS PIPING ' <br /> EXHAUSTFAN <br /> � <br /> � � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL f � SUB TOTAL f <br /> PERMIT E i PERMIT E � <br /> TOTALFEE S � TOTAIFEE E ' . <br /> FOR OFFICE USE ONLY: <br /> LRONT SETBACK RE��SETBA�1( SI�E SETB�LN �l�N CNECB NU�R �EF pEGFIPi NO <br /> S~', <br /> � <br /> usEior�e tot�nen VACANTSIIE FEES VALUATION �EE T_ <br /> � <br /> ❑ves ❑ No ounowr, � _ <br /> NEIGNTLIMIfAT10N NOOFOWEtUNG 52EOLBlOGRI i I <br /> UNIIG PLUMOING i <br /> -� i <br /> OCCVPANCY NJ IX S�M45 OCCUPANflO�D B�SEMENT ' i <br /> Mfp�ANIC�I � <br /> GRWP - <br /> pYE$ ❑ �� � <br /> FIRESPRINKLERRf.O'D �f�5(NJ ADD1110NQPUNCI�f.CB � <br /> �- <br /> on�cn � <br /> FIFEMAliMREO'D �EA50N i <br /> SUIE BUIl01NC SIIRCHARf,[ � <br /> rvrEorr,or+st rinvs�rraoveoar CITYOFEVERETT ruoucwoF�s ' . <br /> _;_. <br /> LOCAL SALES — � � <br /> o�TE TAX CODE IS 3105 TOTAL <br />