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,_. <br /> APPLICATI�..� FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> p DEMOLITION ❑ COMBINATION � BUILDING LI MECHANICAL ❑ pLUMBIN(3 ❑ SIGN <br /> PHOJECT ADDRESS: �c� C� l��ST/J L� � S fl'PQ � , , ;,,+;��3� <br /> OVMEP MML� E55 CIfY � l�� � P11pNE <br /> x S:�n�� Ds � /� � �e 0�-�e/��-- - 3°�° <br /> TeNurt u�ii ess � �m ri�one <br /> � � . �a,�� ��.da�„s1� _ �-v� �������. o J��5�y9� <br /> •RCIIITECTOf10E516NEN �IIAOOnE55 C�IY )p• p11pNf <br /> -- - - ��� 3 5� <br /> OERER�ICONTMGTOf1 u1�IX10E55 CnY � )m P�H)N[ iIUEUCENSE� <br /> �-?/lflIL01/�. ��/ /-� <br /> MECHANICM ONTR�CTOR MeiU00f1E55 crtV )m pIIONF ST�fE IICENSE� <br /> PW11lINOCONfR�Ciqi MNLI10011E55 CIIY (iv � PI10NE STAfELICENSE/ <br /> CONfMCT i1110E OF YIOfIK —----'- <br /> NEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> DElLNIlENVfINANDSW�REfOpiMEINVOLVEO f.f1N1 �:�rFt�rinNnr�� erw 3p�3 � 3AD <br /> C T 1= [�—�-,1 r"� "—T'Q,A � d�<I <br /> �?1L� ' • 3 e- 3 �z12 <br /> I HEREOV CERTIFY THAT I NAVE READ AND EXAMINED TH�S <br /> W10POSED USE OF 8U1LdN0 APPLICATIQN AND KNOW THE £�AME TO BE TRUE AND CORRECT ALL <br /> . PROVISIONS OF LAWS AND OROINANCES 60VERNING THIS TYPE OF <br /> WORK WILI. �E COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> LEOAl0E5CRIPTION OF MIOPERTV�SIqWN BEIOW pl�T7/�LN TWO COI'IES� NDT. 711E ORANTINO OF A PEHMIT DOE& NOT PFESUME TO OIVE <br /> ior e�ocK or AUTFIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTNER STAfE OR LOCAI LAW REOULATINO CONSTRUCT�ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHONIZED BV THE <br /> �( �9� 9 �SSy L/ I � QQ �� —v �wNER OF THIS PAOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> E�ru�i. ,r�we CONTRACTORS LAWj1B.27 RCW AND 298.200 WAC. <br /> CONSIIIUCTION LO/JI lENOER.�DDIIESS.IEIEI`110NE NUM0Ei1 � // p? <br /> SIfiN�1110�� D�I <br /> CIIY fI1151NF.F8110ENSE NO <br /> PLUAMINO MECIIANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET) � NC—MiNDLO UNR9 � <br /> BATHTUB ' FOf10ED AIR SVSTEMS ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT IiEATERS � <br /> KITCHEN SINK 8 DISP ; CI.OTIIES ORYERS � <br /> DISHWASHER � �R�NOE HO00 � <br /> LAUNDRV TRAY � WA7ER I IEATER � <br /> CLOTHES WASHER � WOOUSTOVE � <br /> URINAL � Mf fAl fIREPIACE(1W00D BUfiNIN6) ' <br /> DRINNINO FOUNTAIN � FIR[PLACE INSEHT(WOOD BURNINO) � <br /> FIOOR DRAIN � GAS fIRf:PLACE � <br /> BACKFLOW PREVENTERS ; GASf1ANOE � <br /> SINK(SERVICE—BAR, ETC.) � OAS PIPINa —� <br /> _ EXI IAUST FAN �_ <br /> � � <br /> � � <br /> , -- � <br /> � � <br /> ---- � <br /> SUB TOTAL S ' SUB TOTAL f ' <br /> PERMIT f � PERM�T f � <br /> TOTALFEE f ' TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> ippNTSETPACN AE�RSFiB�CM SIpE$ETB�Ck PIAqf.Ilff.MN11M1 '0 fFF AEf.E1PIN0 <br /> p ' a' � �/ <br /> USElONE �oi enF� vet�nt Sitt FEES VALUATION fEE <br /> C � Z 8 9 � ❑YES ❑NO pllilfllNfi / �O <br /> NEIOHiLIMI7ATION NOOOOWFLLINO SIIEOfBl00Rl --" i <br /> � UNIfF ��IIMIIINfi � <br /> �s ,�r� $yo - -- - �---_ _ - ---- —��--- <br /> OCCUP�NCY NO Of 71MYES Ol:l'UV�Nf IO�U B�SEMENI MF1:11�NII:�I � <br /> OR <br /> ❑YES ❑NO .'—_"__ - � <br /> FlPE6PRINKLERPEO' �F�SON �OU�IIOH�II`IeNCnICM i / .? <br /> L.! <br /> /J J nnmi-------- , <br /> � <br /> FIRENMMPF�'D �F�S(M1 ----- i <br /> N, AI�ICONIIInIfi51�111:11MlllF — __� <br /> "_"_._"___ t <br /> Tvveorr.oNsr rinNs�rnov[nur CITYOFEVERETT runnrwrn�ec <br /> v �„ �Ih �OCAL SALES ---- - ------- ---'-- <br /> __�,���� o+,E ,�, • iy . 9 ? TAX CODE IS J105 ioin� <br />