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APbPLICATI� N FAR CONSTRUC'� .ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISIOtJ � <br />3200 CEDAR STF%EET • EVERETT, WA 98201 • 259-8810 <br />B DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECFiANICAL ❑ PLUMBING ❑ SI(iN <br />PROJECT ADDRESScI 916 Broadwav Everett WA 98201 <br />EverntC Commmitv College 801 Wetmore tverett WA 98201 388-9513 <br />owr�En uui •ooness an nr <br />vua+[ <br />TENANT MAII.l1pplIG55 f.ITY p�p <br />r��oN� <br />ax�urccronnesier¢n u•n •onness ��iy ��„--- <br />QWI1�C riioNF <br />ceHenucann.e�on uui.amess � cnr ---- ..;�,----- --- <br />1'uONI: GI�lE11CCN5[� <br />YELII�NICAICON7qAL10R MML�DORE55 CIiY IIP � <br />PIIDNC ST�TE UCENSE • <br />PIOYBWCf.Oq7RR:fOR YqlADpi1E5S CIIY I�p --- ������� <br />SI�IE IICENSE • <br />Of <br />OE3GNiBEWORKANO50l1AREFO07AGE WVOlVEO <br />l07 010CN <br />5938 180 026 0105 <br />PMGEL TA%IA. MIMBER <br />CONSIPUC710N l0l�N 1 ENItER,11UppE55, IEIEI'110NE NUMBER <br />PLUYBING <br />NO. TYPE OF FlI(TURE OR ITEM FEE <br />WA7ER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH �ASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASNER <br />LAUNDRY TfiAY <br />CLOTFiES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />UACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETC 1 <br />� SUB Tf1TAL f <br />PERMI! f <br />TOTO.L FEE f <br />FOR OFFICE USE ONLY: <br />iRONISETflAGN pEAqSFTB�CK SIOESETB�LIt <br />IISE IONE IOI �RE� VAC�III SIIE <br />❑YES ❑ NU <br />11EIGIIf IIM�T�IION NO Of UW[LIING 51ZE Jf tlUlfi/I I <br />IINiIS <br />❑Y(S ❑ NO <br />flE0'0 <br />RI1E AIAIiM (iC0'D <br />irreorr,ousr -- r�nnserrnov[nuv CITYOFEVERETT <br />LOCALSALES <br />u.n TAX CODE IS 3105 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONGCi PI'RSDII AND 1'110NE NO <br />Mark Stewart 388-9513 <br />I IiERE�Y CERTIFY THAT I I1AVE AEAD AND E%AMINED THIS <br />APPI ICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PHOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHEH SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTf10RITY TO VIOLATE OR CANCEL TfiE PROVISION OF ANY <br />OTHER S�ATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br />PERFOpAIANCE OF CONSTRUCTION. THAT I AM AU7HORI2ED BV THE <br />OWNER OF TI{IS PHOPERTY TO PERFORM TME WORK FOR WIi1CH <br />APPI.ICATION IS MADE AND I COi�.IPLY WITH THE S7ATE <br />CONTRACTORS lAW IB. ('WAN 296.200 WAC. <br />x.J"L�lc �- i ��� � s/i6/�� <br />SIfiN�NP€ — D�fE <br />CITY OUSMESS 11CCN5[ NO <br />iYPE <br />rva.—rvrinuW un115 <br />FOHCF.D AIR SYSTEMS <br />HEATPUMP <br />UIJIT NEATERS <br />WATER I IEAT[R <br />WOOD STOVE <br />METAL FIREPLACE i <br />FIREPIACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />PI I1N CI ICCR NIINfIfp <br />�� <br />ounnnu: <br />1'I111A111NIi <br />M[CI I M�If.�l --�-�-- � <br />AOUI II(1NA� PI AN l:lll GN <br />OII�[II <br />til�Il 111111111�11: Sl�lll.11�pf•L <br />fCP <br />SUBiOTAL S <br />PERMIT f <br />TOTAL FEE S <br />REf.EIPt NO <br />--- — <br />--- <br />rumu wonns <br />_ .._ . _ _ .. ._ . _ ._ - -----�-- <br />TOTAL <br />FEE <br />