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APPLICATIO ' FOR CONSTRUCT: lN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 GEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> O DEMOLITION ❑ COMBIHATION BUIL�DING ❑ MECHANICAL U P�UMBING p SIGN <br /> � <br /> i� <br /> PROJECT ADDRESS:�� v — .3' F I�An cI� �.rQ. <br /> � <br /> pvmen MML�OOt1E55 � cin rm r� <br /> 5����ff e e_ � g z�� 3 9 �'.,,jn�� ��r�e a.s �� � •p`�I <br /> T¢w�+r uui�ooaE cnr 1 y� nvI,` r�rorrt ...' <br /> � arr�, ni1r�� n �'}�� .-�'ii3� .����jip .SJ`� �Il I-C/IP W4�S� � �1 <br /> �aeM*[ SIGNER M�n ss em nr rHor+e <br /> -� /�, n /� -7 / �N a� <br /> oE En�rnl`� u��✓:�SS(.�5�l '"� ^-��b�� �Y.I Mni A/ `m9�Oa � r7N/ y' �l9� uCEr�SE�a��M � <br /> MECN�MC/�LCONTNALTOR MMl�D0RE55 Lltt I�P PIIONE ST�TEUCEN$E/ <br /> PIUTABM/GCpITR�CTOiI M�ILAOIXI[SS CIfY 71P PIqNE StATEUCENSE� <br /> �wi�ucTw�o� (� HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> �wowc��.,sou vooTwemvaveo corrucrr[nsori�narHorvera <br /> - S� <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> °�P°�D ���LD^i0 PFOVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ` ` WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> �aµo¢scnirr avnor�nrv�aawneeiowon�n�cHnvocoriEsi NOT. TNE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �01 e�ocx ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGUUTINO CCWSTRUCTION OR THE <br /> PERFORMANCE OF CONSTqUGTION.THAT I AM AUTNOfiIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WM1CH <br /> APPIICATION IS MADE AND I COMPI.Y WITH THE STATE <br /> PNILfL T/�111.D.NlMlEN CONTRACTOR'LAW 1827 RCW AND 296200 WAC. <br /> CpISTRULiIONIONItENOEA.l100RE55.iE1EP110NEN11MEEN X ' v <br /> 516N1TUfiE DQE <br /> CITY BUSINESd i10EN5C NO <br /> p��Np MECH�NICAL <br /> NO. TYPE OF FlIfTVRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILE� � A/C—AMNDL6 UNfTS ' <br /> BATHTUB � FORCED AIR SVSTEMS i _ <br /> UVATORY(WASH BASIN) � kfEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES ORVERS � <br /> DISHWASHER � RANGE HOOD ' <br /> � LAUNDRY THAY � WATER HEATER � <br /> CIOTNES WASHER � WOODSTOVE � <br /> URINAL ' METAL fIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIR[PLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPIACE ' <br /> BACKROW PREVENTERS � GA3 RANGE i <br /> SINK(SERVICE—BRR.ETC.) � GAS PIPING ' <br /> � EXHAUSTFAN i <br /> � ' <br /> i <br /> � <br /> � <br /> � <br /> � ' <br /> � <br /> � <br /> SUB TOTAL S ' ��B TOTAL f i <br /> i <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETB�CK RE�P SETMCIt SIDE SFTBnCK nl�N CIICC��C/� ���/ � REf.flPT NO <br /> useia+e_ _ ' IOT�REA V�CANTSILE FEES VALUATION FEE _ <br /> �/ � � <br /> � ❑res o rro 'n�.mrnNr. L� J � 7 <br /> HE�611T UMITATION NO OF DWEIUNG SRE Oi BLOGR I - � <br /> i <br /> UNIi$ PlVM01NC — I <br /> 1 <br /> OCCWANCY Iq(%SIptlIS OCCUP�NTlO�D B/�SEMENi MFCN�NICM � <br /> GRpR � - <br /> ❑YES ❑NO � <br /> FIRESMiINKLERREO'D �FASON �DfNIION�II`1�NC�IfGM , � _ . <br /> � <br /> OIII[Il <br /> FlRENMMREO'0 AE�SOH <br /> S1qC OUI10111C SIIIICII�IIQE — ��� <br /> rrvE ov r.or�sr CLANS MPROVED BY CITY OF EVERETT PIIPnf.W(NIKS � <br /> 'JM TAX CODEAS 7 OS TOTAL ����� <br /> o�re �O �3 �lr <br /> O <br />