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APPLICATII.� FOR CONSTRUCS�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR fiTREET• EVERETT,WA BB201 •259•8810 <br /> ❑ DEAAOUTIG�N ❑ COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJEC ADDRESS: 2/ � C�e n T�ee <br />( � i � P�2 c�i �lva d �s�i� 2.2 ? 3f�69 <br /> Eq 4�1l�WPE65 f.ITV ��E <br /> iEN�NT VNIMW�E55 f.IIY 71P f'110HE <br />� <br /> MiL1 RCCT dl DE516NER M�II�OORESS CIIY 7� �NONE <br /> S L - �fzs- S. 4.� �o__.�/.,f o„ w� yr,z�s C3�o) y3r ��93 <br /> ENEMIf,ONIMLTpI M�Il�D011E55 Y l�� ��10NE SI�TEIICENSF� <br /> SoDhRA.roU4/RP <br /> MECN�MCQCONTRACTOR M/uI�ODRE55 dtY lm PIIONE SUIFI�CENSF� <br /> PIUAMINOCpifRACIOR M�II�DORE55 CIfY Zi� PIqNE SGTEIICENSE� <br /> corrtiucivrncEoiwa+K HEATINGSVSTEM: ❑GAS ELECTRIC ❑ W'��� �f <br />' .�,.�� �9,P <br /> OESCIME WOf111�MU SOUAf1E FOOT/�OE WVOIVED C(1�11�C rcns � oNONE NO <br /> � /r v�n er 3C�o - <br /> �� <br /> I IIEREOY CERTIFY THAT I HAVE READ AND E%AMINEO THIS <br /> APPLICATION AND KNOW TFiE SAME TO BE THUE AND CORRECT ALl <br /> riqv�oxo uu ov eu ra PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br /> {�(S��NC Q WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEf1EIN OR <br /> �Ea,LLat�pppPEqiY�51qWNlELOWOR• �CNTN'OCO%E5� NOT. THE ORANTIN6 Of A PEHMIT DOES NOT PHESUME TO 61VE <br /> �oi e�ocK prS� S I,✓if/or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6UUTINO CONSTNUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8V THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> - APPUCATION IS MAD AND I COMPLY WITH THE STATE <br /> CONTRA S LA 18 RCW AND 298.200 WAC, <br /> TM 1 D. � <br /> � �n o .2 �9AS- /-03 - O /�- gb- � <br /> CONS lp�/`EN ,�001�ESS.TELEPIIONEMMBER q <br /> Q� (J(�'n '�.S / SMN�IIII7E O�IE <br /> 3so� /68 �� /-•c. / / �i� pfYBU51`1ES.�rI�CEN5CN0 _� <br /> PLUAMINO MECHANICAL <br /> NO. TYPE OF flIITURE OR ITEM FEE NO. TVPE OF EOUIPMENT FE�_ <br /> WATER CLOSET(TOILEn � A/C—AMNDL6 UNRB ' <br /> BATMTUB $ u�� ; FORCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' . <br /> SHOWER ' S UNIT HEATERS W�� h er � <br /> � <br /> KITCHEN SINK 8 UISP i CLOIHES DRVEHS � <br /> DISHWASHER � RANGE HOOD ' <br /> IAUNDRY TRAY ; WATER HEATER � <br /> CLOTMES WASHER � WOOD STOVE ' <br /> URINAL <br /> � MEfAL FIREPLACE(WOOD BURNING) : <br /> DRINKIN6 FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) ,�_ <br /> FLOOR ORAIN � GAS FIREPLF.CE ' <br /> BACKFLOW PREVENTERS ; GAS MNOE �_ <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPINO ' <br /> � 2 EXHAUSTFAN � <br /> � <br /> � ' <br /> � � <br /> SUB�fOTAL f ' SUB TOUL S ' <br /> PERMIT f � PEFiMIT f � <br /> TOTALFEE f � TOTAIFEE f ' <br /> FOR OFFICE USE ONLY: —. <br /> �f10qT5ETB�CN PE�OSETB�LM $IDFS �B k �I�NCIICCNNUMpffl fCF � �ff.(IPTNO <br /> 1.?� � � �• �0 � � — �.-2 U <br /> u5F ior�� �� lOT ARF• O�� v�c t utc FEES VALUATION FEE <br /> o.ES o�o ' p <br /> auiniH� 3 $ � � <br /> IIEIOII1lIM111TION � NO O�DM' lLINO 512E Of B100/I I � <br /> UNIfG � � � L riuunir�a ____ Z� <br /> / _ � <br /> Q C���Y NO 0�SIMYfS OCLUP�Nf 10�0 B SFMENI MFf.Ilu11CM _____ __ i _ <br /> 3 �- I _ _ ❑.cz er� ; <br /> ♦p(NIION�I IY�N C�Iff.K <br /> F1RE SPRINNlE1111E0'0 �HSON �- <br /> nn¢n <br /> FIREMARMPEO'D AF��OM <br /> Sf�IE 0411DiNf SII�GuIiCE — ��� <br /> rrreorr.or�sr rinNserrnovcoer CITYOFEVERETT runnr.vmnKs _ ��__ <br /> ' / LOCAL SALES <br /> –�1�/ o„�E q TAX CODE IS J105 TOTAL ____ _ ' <br />