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APPLICATI� `l FOR CONSTRUC? .JN PERMIT <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •2b9-BB10 <br /> ❑ DEMOUTION ❑ COMBItiAT10N ❑ BUILDIN(i �MECHANICAL ❑ PLUMBINfi ❑ SHiN <br /> PROJEC AODRESS: <br /> ' ����►4 csr�c � � �,n,�� ,��, 5 s�`�o� �a_3�3�i <br /> R MN�IIOOHE55 C1TY itP <br /> .l1Ai�� <br /> iEIUNt YNlMdK55 CI7Y i1F P�qNE <br /> �RCMiEGTOROE$IONER M�IIAOp1E55 CITY 7�� PIqNF <br /> � �_ �` <br /> OENERILL CONTRIiCfdl MNl I100f1E55 CIIY )m IMqNE Sf�fE IICFNSE• <br /> MECNIIMGILCONTR�CTOA 4Ml I�OORE55 f.ITY ZIP PIqNE CI�fE UCENSE� <br /> RUMlR16CONTR�TOR 441/�00f455 CIiY tIP PIqNE ST�fELICFNSE• <br /> CONTMCT PIMCE Of YY011R <br /> �� � HEATING SYSTEM: (iAS ❑ELECTRIC ❑ <br /> WpM 11ND F00T110E MVOlVEO CONT�LT VERSON N1p PM]NE NO <br /> r � � <br /> Q�Ihn�f'�� �jp� ��I �� �iG\ 1\4�1 - <br /> I HEHEBV CERTIFY THAT I HAVE READ AND EI(AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rwroxo u�a suKnra PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THI6 TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> iEOKOEecwnrqnav�ar¢nnls�qwpeeiowan�n�cnrwocaAesl NOT. THE ORANTINO OF A PERMIT DOES NOT PREBUME TO OIVE <br /> �pT �pp� a AUTHORITV TO VIOLATE OF CANCEL THE PROVI610N OF ANV <br /> OTHER STATE OR LOCAL LAW REOULATINO CONSTNUCTION OR THE <br /> PERFORMANCE OF CON5TRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> ' ONMER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITN TME STATE <br /> �E�T�u i p M�p WNTRAC S LAW 1B.27 RCW D 288.200 WAC. <br /> s�;,►a� � ooa - c�ol� - � -�, _�� <br /> CONBIRIICTION IOIN LENOER.110d1E6S.fELER10NE MMlER X <br /> CJON�IIIIE WTE <br /> '�a'1 �S 1 <br /> crv eusn+Eu i�ceNsc ra <br /> N.I1wM0 MECNAIMCAL <br /> NO. TYrE OF flRTU11E OII ITEM FEE NO. TYPE OF EOINMIENT FEE <br /> , WATER C"�.OSET(TOILE� � NC—AMNpLp UNf1g � <br /> BATHTUB ' FORCED AIR SYSTEMS ' <br /> UVATORV(1NA3H BASIN) i HEAT PUMP � <br /> 6HOWER � UNITHEATERS ' <br /> KITCHEN SINI(6 DISP � CLOTHES DRVERS � <br /> DISHWABHER � HANQE HOOD � <br /> Ul1NDRV TRAY � WATER HEATER � <br /> CLOTHESWII3HER � WOODSTOVE � <br /> UfiINAL � MEfAL FIREPLACE QNOOU BURNINO) ' <br /> DRINKIN6 FOIXJTAIN � FIREPIACE IN5ERT(WOOD BURNINO) � <br /> FlOOR DRAIN � fiAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GAS RANOE ; <br /> SINN(SENVICE—BAH,ETC.) � OA3 PIPINQ � <br /> � IXHAUST FAN <br /> � <br /> i � <br /> i � <br />. SUBTOTAL f ' SUBTOTAL f ' <br /> PERMIT i � PERMIT S � <br />� TOTALFEE f � TOTALFEE S ' <br /> Fon o�ce use oN�r: <br />' iRONTRE1BAdf REMSFiMLk 610E9FTMCN M�NCIIECkNIMfR FF 11FfFIPI/q <br /> us¢tdc ioT�r�� VAC�NT5IIE FEEB VALUArON FEE <br /> ❑YES O NO BUIIDIN(i I� I <br /> I 11[qNT 1I41f��lON NO Oi OWEllINO SIZE Oi BLONfI <br /> UNIf[ Pl11MflM0 i <br /> OCCUPIINC� IID p SI(MY(S OCCIMANf LO�D BASEMENT + <br /> Q�� MECNMNCAI <br /> ❑YES ❑NO �-- ��� <br /> •DOIIION�L R�NCNlCM i <br /> FYIESN11qIfLEPREO'D PF�Sd1 --�_ <br /> OIIIER � <br /> i <br /> FIHEILLMMREO'O RF�SON i <br /> S1�lE BUIIOMO SIIIIf,H�MiE i <br /> � <br /> _ —_ r� <br />� irre ov r,opsr wnHs ervnoven er CITY OF EVERETT runnr,wonns ' <br /> LOCALSALES --- —�— <br /> o�iE TAX CODE IS 7105 TOTAL � <br />