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APPLICATI( ^1 FOR CONSTRUCT �N PERMIT <br /> CITY OF EVERETT•BUIIDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION�- �Q � BUI DING/� ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> PHOJECT ADDRESS: �UGD U"LC�'Y�DO��./(/4 J <br /> ��is�t�e2i-.�-c. /HozH-bNr�9vaw. �B.rvera� y"B"ozG Zuc - r'+� -76s'Z <br /> �( M�Il�00i1E64 r.m rm rNopE <br /> IEN�Nf V�Il�f1011(SS f.iir 71n PnONf <br /> 1111L11ITCCTdIDE516NER MMl/�00f1f55 Cirv 7�� P1qNE <br /> /�YR�I /H.� e7G/'/ i pYlon��.�..�.� C"ul�eE/Y �/'F3• ! 20G • .YS.S"- �' �i 9 <br /> OENEMlCON10�CTOf1 WNIMDRF55 f.AY !iP P�WNE SI�1ElICCNSE� <br /> �Cd-<i2 Z'.�t �y°a'I 6V"'AuG /�,� �d/1J�NO3 '18�.'T 6 Z��- 7d:�- 7L�f"Z <br /> I:.�1'� MECN�NILACONTRACTOR MM�OW1E55 f.ltt 11i` PIIONE SI�fCLILF.NSF� <br />��., <br />. O/� s +s n- /)u�ysv� �c <br /> t��''� � %U4EINOCONfRId:fOR M�Il�D0i1E55 d�Y I�� PIIONE STMEIICENSE� <br />�'�:' .. ' L+�F�_y'.O-R� ' If/J�RSC�/L�� <br />� CONiMCf PIMGE Of MW�N � NEATING SVSTEM: �4 GAS ❑ ELECTRIC ❑ <br />�k;; � i ���79 - - <br />[�:.'� . � DESpNBENV111f�ND50l1�REFOOTW WVOlVEO f,f1N ON�11� ONE <br /> f <br />���'�� �..� . � / <br /> —.�n� C A.C72.� �ie � <br /> I HEREDY CERTIfV THAT I HAVE READ AND EXAMINED THIS <br /> — APPLICATION ANU KNOW THE SAME TO BE TqUE AND CORRECT Al.l <br /> P110POSEDUSEOFlUl01N0 PpOVISIONS OF LAWS ANO ORDINANCES GOVERNCiG TNIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HcFEIN OR <br />� i[oaoeacrorrroMorpnorEnnls�awr� rn�renecnTwocoriesl NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> �oT � eioac�or--t7.1��Rr 'QS�E aUTHORITV TO VIOLATE OR CANCEL THE PNOVISION OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.TNAT I AM AUTHOHIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOHK FOR WHICH <br /> APPLICATION IS MADE AND I GOMPLY WITH THE STATE <br /> PA110El TlU11D.M1MlFR CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br /> LONSf1NLTI0NlO�NlENOER,�DOnE55,fE1ER10NENUM8E11 �((/.�./� /�! / '//'I��" � //� /�� <br /> w � � SION/�l��if D�IE <br /> l �h/�.rJ �� Cl/�/[O/N �/(� �/ qIYBUSINE55lICENSCNO <br /> /� ��1 <br /> PLUIMINO MECHIINICAL <br /> N0. TYPE OP flXTURE OR ITEM FEE NO. TYi'E OF EOUIPMENT FEE <br />� WATER CLOSET(TOILEn � � NC—AMNDLO UNRS ' <br /> BATHTUr ; FORCEDAIRSYSTEMS ' <br />� UVATOHY(WASH BASIN) � HEAT PUMP � <br />� SHOWER � UNITHEATERS ' <br /> KITCHEN SINK 6 DISP i / CLOTHES DRYEFS � <br /> DISHWASHER � RANaEH00D ' <br /> LAUNORYTRAY ; / WATER HEATER i <br /> CIOTHE3 WASHEF � WOOD STOVE � <br /> . URINAL ' MEfAL FIREPLACE(VJOOD BURNING) ' <br /> ORINKIN6 FOUkTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPUICE ' <br /> BACKFIOW PREVENTERS ; GAS RANGE � <br /> SItfK(SERVICG—BAR.ETC.) � (3AS PIPIN6 ' <br /> — E%HAUST FAN <br /> _ � <br /> � ' <br /> ' � ' <br /> i ' <br /> T � <br /> 1 <br /> � � <br /> SUB TOTAL S SUB TOTAL f <br /> PERMIT S � � P[HMIT f � <br /> TOTAL FEE f �_ TOTAL FEE S ' <br /> FOR OFFICE USE ONLV: <br /> if10NTSEfBACK pE�115ETBACR S�OESEIB�Ck �UNCIII:CKNIIl10ff1 f[F 7u QFf.(IPiNO <br /> 2S� 25� s � � — <br /> uat iLUF � �ot en¢e VAC�NI SIIE PEES VALUAT�ON FEE <br /> � <br />� _ 1`-� 'li / 7 � r[s ❑Ho nwinwr �JO ZZS �• � � � <br /> NEIOIITLIMIIRIpN NOOiDWEllllq SUEOiBIDORI / ^'� <br /> UNII6 � �` p111MpIN(i 1LK, <br /> �Y r. <br /> anC��NC� NO IXSIM[S OCCUP�NiLO�D B� E4ENt ��� � <br /> .,,� Mf1:11�NICM i <br /> ,� V�! ��__ ❑YES— IYn�i �_s� ;, ✓ <br /> �OO�IION�I M�NC11fCM � <br /> FIf1E P111N1(IERREO'D �E�SON <br /> _— i <br /> ourtn �—�!I— <br /> (IREMAi1MIlE0'D pF��Of1 — . li r <br /> SI�IFOIIII�IN05�111CIUIIfE �'�j� <br /> rrre or r.onsr wnNs�rrnov¢o er CITY OF EVERETT nnxnr,vmnKs � <br /> IOCAL SALES — ---""— "-- '�/ n ' <br /> o�iF TAII CODE IS 3105 tOTAL Y J� <br />