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, � <br /> APPLICATION FOR CONSTRUCTIQN PERMIT� <br /> CITY OF EVERETT•6UILDING OIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 982U1 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ � LUMBING � SIGN <br /> PRflJECT ADDRESS: 3p9 cp,f �,s.�.o � <br /> �.a;f{_T., vr�T�s,�o ��rr,(J ,wL o.�i4. �. �a( 20o��.lA� tJy'/o✓ Sto�Mh.WA9eiig (7ot,) ,28r-2zor <br /> pyA�p� G�4�DDnEss f.irv T�r r�qNE <br /> '�1`�1'��-."�P'b 30�E+,�G • ,t.( E���i' �,.1/� 9B1eB (y��l ��osG�G <br /> IEH/JI M�IlM10�f55 CpY IIP P19 E <br /> 1111CIUlCCT0110ES�OHEf1 M�Il�D011E55 CIIY 711• P�qNE <br /> I� r�.��lte�[e. �.6. 13o-csyb4 L �ufc� ��° a ' 77G-BQ7r�EQNN�n7�c 4 <br /> Ep H(NJ. q11MCfOn Mut�U0nE55 � G�Y Ji� N�OME 51�tE4CENSE� <br /> MECH/iMC�LCONTO�CIOR MNlADp1E55 CIIY )IP PIIONE STATEUCENSE� <br /> 1'IUMEINOCONIRACI0l1 M�Il�00f1E55 CIIY IIP PIIp�E SIAfEI�CENSf.� <br /> xarucrrniceovwonK HEATINGSYSTEM: ❑�+AS ❑ ELECTflIC ❑ <br /> 2 d o0 <br /> ESLPIlEWOON�NOSOUAPEfOOTI�OEINVO.VEU CONfACtP[n50N NONENO <br /> / Z.�,f I( �/'< Y�6''D•d.�-„ �.�.,1 ti,l�.11 • �a r,d�16.,� <br /> �— (`�Z.S�7710-B£r3� <br /> -,�� l , •� �.6• <br /> � I HEREOY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br /> APPLICATION AND KNOW 1HE SAME TO BE TRUE ANO CORRECi ALL <br /> •naose se or eu�oI�r+a/ PROVISIONS OF LAWS AND ORDINANCEu GOVERNING THIS TYPE OF <br /> Cnnrt�^t�-Toe�It S+ rc WORN WILL BE COMPLIEO WITH WH[THER SPECIFIED HEREIN OR <br /> �EeµpE,�RiP �a+a enn�sa�wnnowa��n�c�iv�ocoMes� NOT. THE ORANTINCi OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> LOT _s��� o� AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OiHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br /> S GL �,� IG-. PERFOFlMANCE OF CONSTRUCTION.THAT I AM AUTHOAIZED BY THE <br /> OWNER OF THIS PROPEfITY TO PERFORM THE WORK FOR WHICH <br /> • APPLICATION IS MADC AND I COMPLY WITH THE STATE <br /> PMCELTN!10.NUMBFN r - CONTRACTORS LAW IB27 RCW ANO 296.200 WAC. <br /> S dd " ��,.:��'O D-,�O-�.� <br /> CpN$T11UC1HM!LOMI lENOER.M0�E54.tElF.M10NE NUMflE� _ <br /> CqN�IURE O�IE <br /> �1�/7 R6 <br /> tin ausuress��ceNsc r+o <br /> PLUMBINO MECMANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYVE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NMNDLQ UNRS ' <br /> BATHTUB ; FORCEDAIRSYSTEMS i <br /> UIVATORY(WASH BASIN) i HEAT PUMP ' <br /> SHOWER � UNIT NEATERS � <br /> KITCH�N SINK 6 DISP i rLOTHES DRVERS � <br /> DISHWASHER � �J�NGE HOOD ' <br /> UUNDRY TRAY � WATEH h1FJQER � <br /> CIOTHES WASHER � WOODSTOVE ' <br /> --- � MEfAL FIREPLACE(WOOD BURNIN6) ; <br /> ' URi1JAL <br /> � DRINKIN6 FOUNTAIN FIREPUICE INSERT(WOOD BURNIN6) � <br /> FLOOH DRAIN � GAS fIRF.PIACE ' <br /> �_ � <br /> BACKfLOW PREVENTERS ; GAS RAN6E � <br /> SINK(SERVICE—BAR,ETC.) � (3AS PIPINO ' <br /> � EXNAUSTFAN � <br /> � <br /> i <br /> SUB TOTAL S ' SUB TOTAL f � <br /> PERMIT f � PERMIT f � <br /> TOTAL FEE S � 70TAL FEE S ' � <br /> FOR OFFICE USE ONLY: - <br /> rppqT5E1B�CN REAOSEfB�Ck S�Of5E18eCK �UNCIIECMmI��� fEF �/ �ECEtP�N//- <br /> (Y ` f � 5 4 ly v <br /> VSF70NE lOt�nE� V�C�NISIIE <br /> FEES VALUATION FEE <br /> � �.ES 0� 2 � ' <br /> OUIDIN(l � <br /> NE�ONTU TIO�/ NOO�OWElUMO 512EOfBlOM1 � <br /> i <br /> ^ (�l� UNIfF PU1401HO <br /> r� ---� <br /> ,x��NC� NO p S�fMb[5 OGCWANI LOAU B�5[MENI MFCII�NIC�I � <br /> 3 — � <br /> OYFS O Nn � <br /> -- AUpfl(M!q IRAN dR.CM � <br /> =IRElMIM(IERREO"J 11E�SON — <br /> i <br /> omen � <br /> -�R(/�pMREO'O �F�SON � <br /> S1�1EOUlInMO51PIC1untlE _ '�j <br /> rvvEovr,oNst rtnNseroo er CITYOFEVERETT run�x:vrones <br /> LOCAL SALES - — �� <br /> D��E �'�� .�q � TAX CODE IS 9105 TOTAL <br />