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�, - <br /> APPLICATI�..� FOR CONSTRUCT �t�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVEFETT,WA 9B201 •259-8810 <br /> p DEMOLITION ❑ COMBINATION ❑ BUILDING � MECMANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: _ �G G 2 G�4 O �/ � .� n <br /> 01N�ER M�iI�DOnE55 prv 7m rNONE <br /> .�.7UN.vA �C' <TE.✓v/.Y 7ovz Ca✓�y ,��:0 ygZo 35 � 3i9 � <br /> TEN�NT 4�IlMWf55 CIIY )In PIIONE <br /> ♦RLMTCGf pi pESIONER Mul�p0�IE55 CRY JiP PqONF --� <br /> OENER�ICONt1UG101i MAq�p0�f55 GIY �IP PuONE SfUEl1GEN5E• <br /> MECNAMCµCpNTR�LTqi MUTA�Uf1E55 f.IfV TR PIpNE ST�TEIICENSE� <br /> _L�% C �b -2 <br /> PIUMlMOCONTP�CTOR MAI��ppRE55 CIIY 71P PIqNE ST�IELIGENSE� <br /> CONIRACI P1110E Oi Vq111t <br /> _ �.�1 C> 7, a�' HEATING SYSTEM: ($'GAS ❑ELFCTRIC ❑ <br /> �ESGRIlE Y/JIIK�NU SOU�RE FOOT/�bE W VOIVEU f.OH1�C1 Pf tI50N M1�PNONE NO <br /> O�✓✓('QT .O — Ar P <br /> �_� � <br /> �� I 11EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P11d'OSEOUSE Oi DUtdNO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEHNIN6 THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�l0E4CPoPT10NOFPIpPER7Y�51qWNEE�OWd1�TT6LNTWpCOP1ES� NOT. THE �RANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> ior e�oc� _or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW HEODUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNEH OF THIS PROPEfiTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATIDN IS MADE AND I COMPLV WITH TME STATE <br /> PANLEL P1M 1 D.MIUBER CONTRACTOPS L l RCW AND 298200 WAC. <br /> CONSIIIVCTION IONI IENDER,�OOPESS.fEtEP110NE MA/EFR x � <br /> SION O�IE <br /> CITY BUSINESS IICfHSE NO <br /> FLUMSINO MECHANICIIL <br /> NO. �YPE OF FlKTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—ARINDLO UNR3 � <br /> BATHTUB ' FORCED AIR SVSTEMS � <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 6 OISP � CLOTHES DRYERS � <br /> _ DISHWASHER � RANGEHOOD � <br /> LAUNDRY TNAY ; WATER HEATER � <br /> � <br /> CLOTHES WASHER � WOOD STOVE , <br /> URINAI � MEfA;.FIREPLACE(VJOOD BURNING) � <br /> DRINKIN6 FOUNTAIN i FIREPLACE INSERT(WOOD BURNINO) � <br /> FLOOR ORAIN � GAS FIREPLACE �— <br /> BACKFLOW PREVENTERS � (3A5 RANOE � <br /> SINK(SERVICE—BAR,ETC.) � ,3 OAS PIPINO � <br /> ' EXHAUSTFAN <br /> � <br /> � � <br /> � � <br /> SUB TOTAL t ' SUB TOTAL f ' <br /> PERMIT f � PERMIT f � <br /> TOTAL FEE S � TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRONTSETEl1L4 RE�RSF.IB�CM S�OFSEiB�Ck hl�NC11ECKNU>F11 fEf �ff.FlPtlq <br /> O� <br /> usE iart lOi�RF� V�C�NT 41IE FFES VALUATION fEE <br /> ❑rE9 O M� p�lDwrt i <br /> NEIONT UMi�TqN NO Of OwEtU1q rIIE Of 1100/f l � <br /> UNIIS P111MOIN0 i <br /> T <br /> (1(:C^��NC1 NDdfl(MYFS OCLVIMNIIO�D B�SEMFNT MECIUHIL�I �- <br /> 0 <br /> ❑YES ❑NO - � <br /> fINE6PRIN1(IERPEO'0 �E�Sp1 �OO�IION�LIR�NdICCM � <br /> 011lE11 � <br /> flREAURMqEO'0 AF��fk! � <br /> ST�I[OIIq�IHO5110C1u06E i <br /> _' ��_ <br /> rrvear,wsr rinNsernnovtoer CITVOFEVEREIT ruqur.vmnes <br /> LOCAL SALES — --'-- <br /> D��E TAX CODE IS 9105 TOTAL I <br />