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APPLICATI' N FOR CONSTRUC'�`ON PERMIT I� <br /> CITY OF EVERETT•BUILDING DIVISION �C,���J <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 �7! <br /> L5"DEMOLITION ❑ COINBINATION ❑ BUIIDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS:_ ��p�, e� /, ,�,�,�•,N f, , , �. <br /> F✓fRE7f 6aSPt� rnrss�oi..I Pn 8ox a; � <br /> � f✓c,zf'�"r 9fraa1 e7�.,� d7�b <br /> OW11ER 41UL�ODRE55 nn 11P PNpNE — <br /> VACAnJT <br /> IENIJIT MNL�DqiE55 GIIY JIO PrqNE <br /> �RCMT[�TORDE516NER M�ItADOqE55 CITV [In 1'NONE <br /> �• C1TY 6F' CVERF7T F�RE �fPAaTr>>E �7T <br /> OENERI�ICONfR�CTOq MNtAD011E55 GtY tIP PIIOHE SGiEIICENSE� <br /> YECNANIC/yCONTR�CTOR NNIAOORE55 fJiY tIP PIIONE ST�iEIICENSfr <br /> PIUYlINO CONTRACf011 YMl I10DNE55 Cltt (IP PNOAE SIATE LILENSE/ <br /> CONTMCT PiMCE Oi Wq1N <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑. <br /> � DESCWlE MVNIf Ah0 SIXI�RE FOOT/�pE INVOLVED Cq11�Cf PEfI50HN1D P11pNE 1q <br /> . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoros¢o us¢or eu�ana APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNIN6 THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br /> icaµoescwrna+avnrncnn�s�ahmseiowaa�n�cNrvqcones� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocrt oc AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REODUTINO CONSTRUC?ION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUiHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 5 93G . G,S-7_ pi 3 -o o c�c� APPLICATION IS MADE AND I COMPLV WITN THE STATE <br /> wwcE�rNc i.o,uwean CONTRACTORS LAW 1827 RCW AND 288.200 WAC. <br /> � <br /> CdISTRUCIqNLOMIIENDER.�Dd1ESS.TElEP110NEM1MEER X ����A.� �1. �/��n ✓ S�/.�p/yG , <br /> SION�TURE ���� <br /> D�1E <br /> CITY 9UgN6S5 L1CFN5[NO. <br /> ���� MECNANICAL <br /> �NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILEn � NC—NHNDLO UNITB � <br /> BATHTUB ; FORCEDAIR SYSTEMS � <br /> r <br /> UVATORY(WASH BASIN) r HEAT PUMP , � <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 6 DISP i CIOTHES DRVERS ; <br /> 016HWASHER � RAN6EH000 � <br /> LAUNDRV TRAV � WATER HEATER . <br /> i <br /> CLOTHES WASHER � WOODf��OVE �— <br /> URINAL � MEfAL FIqEPLACE(VYOOD BURNING) � <br /> DRINKINQ FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) i <br /> F100R ORAIN � � (iAS FIREPIACE � <br /> � BACKFLOW PREVENTERS � ; (3Ag p�WpE � <br /> SINK(SERVICE—BAR.ETC.) � OAS PIPINO � <br /> E%HAUSTFAN <br /> � <br /> � , <br /> i � <br /> � <br /> —r— <br /> SUB TOTAL S ' SUB TOTAL f ' <br /> PERMIT f � PERMIT f � <br /> TOTALFEE S � TOTALPEE f ' <br /> FOR OFFICE USE ONLY: <br /> i110NTSFTB�LIf P(MSETB�CK SIOE6ETB�CM Pl�NC11ECMfNMBEN FfF OFCEIPTNO <br /> useip+¢ IOT�RFA VACµt51tE FEES VALUATION FEE <br /> � OYES ❑ � BUIlDIN6 � <br /> � <br /> NE1611T1i�IT�TqN /q pFpWE���p bltEOillDO/fl � <br /> UNIIF P�pMlINp � <br /> OCCUV�NCY Iq d SIM[S OCCUP�N�IO�D lASE4ENT i <br /> 0110UP MFCN�MGI � <br /> ❑YFS O NO <br /> �DDIIION�I fY�N C��f.Ck � <br /> flNESPIdNI(LEqREO'D �E�SON i . <br /> 0�11E11 � <br /> iIREAIAIIMREO'D RE�SOn � <br /> ST�iE BUIIP�N(151111LIUf10E � <br /> 1 <br /> trveorr,oesr nuwsevvnoveoer CIIYOFEVERETT rueiMwor �c � <br /> LOCAL SALES ---;— <br /> o�iE TAX CODE IS 9105 TOTAI _� <br />