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APPLICATIL,�1 FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION �i� <br /> 3200 CEDAF� STREET•EVERETT, WA 98201 •259-BB10 � <br /> ❑ DEMOLITION p COMBINATION ❑ BUILDINO p MECHANICAL ❑ pLUMBIN(i f_7 SION <br /> PROJECTADDRESS�5G3 C��� ���� <br /> �R MMlMp1E55 CITY IIP p�pNE — <br /> �-�-Cp DEJc-Lc�P�Et.�T �r.rc. r��r,e�s2w SNo<-toM�sra yezg� 3�0 ��8- ���� <br /> H� uN��oanes5 cnr ria r�anc <br /> CouN�7cY 2oR�3 c�c�rG�t 23� McRAC R�. 1S.E', �{Ru�Jc,io�.l 93Z23 3�0 �52- �53� <br /> �NCMRCTOppE51GNfN M�I111pppE55 CI1Y 7�P PNONF <br /> 5r�--lLo DC�''. i f�3 C . <br /> fiENEIGLCONIpl1GTd1 MAll�00NE55 LtlY IiP MIONF. AGIEIIClNSE1 <br /> 11FCNIINI�III f.(MlTR�CTp1 MAtI�DDi1E55 f.OY IIP PIIONE SI�TF IICENSE� <br /> 1'�t2o�.( t-l��iNU �M�t�,c<7"tzi Zo�o7v5393o <br /> MUMBMiCONTRACTOR M�ILNqRE55 Clry zP r�E <br /> '�Tr' EN.��-�Z��� St�TEIICENSE• <br /> � SNokcMiS!-� "3bo�2��Y�y <br /> CONiM.,t PRI�E Oi WOf11( <br /> MEATlNG SY:iTEM: �GAS ❑ELECTRIC ❑ <br /> DESGW9E M�711M�MU SOU�PE CWTh6E MlVOIVED LdI1�C1 PF.RSON�I.O PNpNE Iq <br /> C �r-SSTIZuL[_� 2$13 �� ` 5Cz-R ���N 'SC-Lt�l • Zo(� �7� - �03`� <br /> !?(��ICc StZ�n! � Lo(n ��_ ~'_$-'� <br /> . � <br /> I HEREBV CEqTIFV THAT I HAVE READ ANO E%AMINEO THIS <br /> wiavostouse a eu�dia APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> S r-� PROVISIONS O�LAWS AND ORDINANCES 60VEPNIN(i THIS TVPE OF <br /> �����PT��P�=pT�'1�'+��OWMBELOWORIIRACNTMqCOPIES� WORK WILL BE COMPLIEU WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE ORANTINO OF A PERMIT pOES NOT PRESUME TO UIVE <br /> �Or 2 µ�K � BRA���r l�F I AUTHORITV TO VIOLATE OR CANCEL THE PROVI610N OF ANY <br /> 5�3 C/�l�`') �Z�A 7 OTHER STATE OR LOCAL LAW RE6UUTINO CONSTRUCTION OR iHE <br /> PERFORMANCE OF CONSTqUCTION.THAT I AM AUTNOHI2ED BY THE <br /> OWNER OF THIS PqOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PNICEL TM IA.MIMBER CONTRACTORS LAW 1827 RCW AND 288.200 WAC. <br /> COMSTRVLTION IOIW LENDER.1100NE55.iElEPl/d!E NUI/!Eq Z � � Z_"J(Z",� �cf/ <br /> L ( �o <br /> 5� D�TE <br /> LITY 9UylIE55 LICENSC lq <br /> ��� MECNANICAL <br /> NO. TYPE OF FlIITURE OR ITEM FEE NO. TYPE OF EOIMPMEM FEE <br /> WATER CLOSET(TOILEn � A/C—iyHNDLO UNIiS � <br /> BATHTUB ' FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BAS�N) � HEAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> DISHWASHER � HANpE HOOD � <br /> � <br /> LAUNDRV THAV � WATER HEATER � <br /> CLOTHES WASHER � WOpDSTOVE , <br /> URINAL � METAL FIREPUICE�YVOOD BURNINO) � <br /> DRINNINOFOUNTAIN , FIREPLACEINSEFiTQNOpDBURNINO) �— <br /> FLOOR DRAIN � 6AS FIREPUICE � <br /> BACKFLOW PREVENTERS ; OASRANGE � <br /> ?'NK(SERVICE—BAR,ETC.) � GAS pIpIN6 � <br /> . ' IXHAUST FAN �— <br /> � � <br /> � � <br /> � — <br /> � � <br /> SUBTOTAL S ' SUBTOTAL f ' <br /> PEHMIT S � PERMIT S <br /> TOTALFEE f � TOTALFEE f <br /> FOR OFFICE USE ONLY: J����� <br /> �110MT SET011C RE�R SfT&1CIf SIOE SFTB�CN <br /> � � � �� / � � Iq�NC11�MNU'MAf11 (E�'/J � RFf.flPTHO <br /> �iV <br /> �sE zo�E � l07�REA v�c�Nr s�re FEE6 VALUATION FEE <br /> _�% � � Uv[5 ❑rvo �/ , <br /> eimrnea (o �d L <br /> HEbNT UMIf1i1 � �'Q pWEWNO 512 �r Bl0g R� C �� �Q� <br /> /�'7 Sr, Gi�/i.JC� 1� riucmwa � � Ov <br /> I' 'Artdt+E <br /> OCCUPANCY Iq[M 51(q[5 OCCUPNII IO�D 111$E1,IEN1 -- <br /> O MECN�NIf.M //p i Cv <br /> -3 d•i 2 ❑�E5 � —_ <br /> FIRE PRINKIEflPEO'U PF�SdI �Op110N�1„I�NC��(CN <br /> _��_- <br /> 011ffR <br /> FIREUMMqEO'0 RF�cON <br /> r — <br /> 9�1EPIIIIDINO51111f,lunOE ' [�� <br /> J_ <br /> rvrear.ar�sr PI�NS�PPnQvrper CIT�OFEVERETT MIqI1f.WOpNS ' <br /> __ / J kl- LOCAL SALES ---_ _ �,_;�� <br /> ,�V oert 3 Zv fG TAX CODE IS J105 TOTAL ; �� <br />