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APPLICATII i FOR CONSTRUCI .aN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-BB10 <br /> Ltl DEMOLITION ❑ COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBING ❑ Si(iN <br /> PpWECT ADDRESS: o;7c;Z C'ol i�c+hv� rF ��c•a.•}�-- <br /> r <br /> Fvea�rr GOSGt� mrss�o�..l P.n. �3ox .la3 E✓F,�F�T 98ac I do.,�- �/��b <br /> O�M1ER uul�pol_55 LITY IIP p1pr1E <br /> VACArt�-r <br /> lENN1I uIJlllppq(55 Grr tIP rIqNE <br /> 11RG�RCiq10E510NF11 MMl/�p011E55 �ITY Jm nNONE <br /> C�rY �F eve.�F1T FraE �EP�ar�+,r t+T <br /> OFMER/LLGONiR�CfOR 441�00f1E55 L�fv bP w1pNE SI�iEIICENSE� <br /> UECNMlICALCANTR/�CTOR Yµ�pORE55 f.IIY 21P PIqNE !:T�IiIICENSFr <br /> PLV4lN6LONIR�CTp1 M�I11100RES4 CIfY Z�P PNOHE STATEIICFNSE� <br /> corrrrucr rwce a wanc <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC O <br /> , OE7CPIlE W�711M 11ND Sd1ARE i00T110E MVOLVED CpRACT PERSON NIO P11d1E Np <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��p���� APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNIN6 THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> �aKotsawnwawav[antS�awHeeioww�rt�cNtwoeaa�esi NpT, THE ORANTINO OF A PERMIT DOES NOt PAESUME TO OIVE <br /> �rn xacK a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR TME <br /> PEPFORMANCE OF CONSTRUCTION.THAT I AM AUTHONI2ED BV TNE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �93 G - �.57- oi 3 - o APPL�CATION IS MADE AND I COMPLV WITH THE STATE <br /> py��Tµ�p,M�p CONTRACTORS LAW 18.27 RCW AND 298200 WAC. <br /> CONS7PULT011LONILENOER.AODf1E59.TELEP11dIEMMEER X fl'14«.�z�.� �)�, �lirnnQ�✓ �2B'�G <br /> SION�7URE D�TE <br /> CI7V BUSn1E55lICENSE NO <br /> •LUIMINO MECHANICAL <br /> N0. TtPE OF FlIITURE OR REM FEE N0. TIiE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � �_�p�p�Rg , <br /> BATMTi19 � FORCEDAIR SYSTEMS � <br /> LAVATOqY(WASH BASIN) � HEAT PUMP � <br /> S��R ' UNIT HEATERS � <br /> KITCHEN SINI(6 DISP ; CLOTHES DRVERS � <br /> DI6HWASHER � MN6E Fi00D � <br /> ' LAUNDRY TRAY � WATER HEATER � <br /> CLOTHEB WASHER � NrOpD STOVE � <br /> URINAL � METAL FIREPUCE�N000 BURNIN(i) � <br /> DRINKIN6 FOUN'AIN � FIREPUCE INSEFiT(WOOD BURNINO) � <br /> FLOOR DRAIN � (3AS FIREPIACE � <br /> BACKFLOW PREVENTERS ; OASRlWOE ; <br /> SINI((SERV�CE—BAR,ETC.) � (3A5 PIPINO � <br /> ' IXHAUSTFAN ' <br /> i <br /> � i <br /> � � <br /> SUB TOTAL f ' SUB TOTAL f ' <br /> PERMIT f � PERMIT f � <br /> TOTALFEE i ' TOTALFEE S ' <br /> FOR OFfICE USE ONLY: <br /> iR011T8ETeAC1I RFM$Eib1CR SIOESFTB�CK 1'l�NC11EC1(MIMBER fEF pFf.EIPTNO <br /> / <br /> �tore �ot�a[� vnG1NI51fE FEEB VALUATION FEE <br /> Ores O ra 9unOm6 <br /> � <br /> IIEb11TLIMIfAT10N NOOFOWEllllq NlEO�El00Rl � <br /> UMiF PlI14BIN0 i <br /> —+� <br /> OCCUPANCY IqOfSlplEi OCCW�NTLO�O S�SEMENi MELN�MC�I � <br /> ar�a� <br /> OYFS OM i <br /> FIREBPPoNI0.ERRE0'D 11fA50N �Dp110N�LM�NC11fCK � . <br /> OTNER � <br /> i <br /> Fb1ENMMREO'0 AF��ON � <br /> St�tE BWIOMb SUIICIIUIOE i <br /> �� Y� <br /> TYPEOff,ONSt Pl�NSMPROVEDBY CITVOFEVERETT �I�RIIf.WORMt <br /> LOCAL SALES — --'-- <br /> o�TE TAX CODE IS�105 TOTAL <br />