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APPLICATII.rI FOR CONSTRUC7 _JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT.WA 98201 •259-BB10 <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDING ,�MECHANICAI ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRES3:��'C ( E I,�' /n .�;� �� ,�� ��� ��,�,'� <br /> owr-�t�a^ � / wui�noness �m �m / r� +� <br /> �YS /':�� /^��li /-� L�/e /1 .i ��'l� � `��i� t,'�{Ai ', ��/ L'��L�F�� y��41�) <br /> TENIINT wNl�00RE55 f17Y /IP i'��ONE <br /> •RCMTCCT011DE516NE11 41111�DdIE55 GIT' 711' PMOMF <br /> OENEtULGONIR11C10R MN1�0011E55 CitV J�� PnONE GI�fE110EN5E� <br /> 1j� l4/A�JC'�f-'A7'-'�� =���/lQ ��c,C��r�� �E A �1.,�,'' "� �s� -�(��,•7 Il Q71(��l�fin�r•v1 <br /> �cMuntucor+ra�cTon Mu r,00�ss r.irv nr r�arvc SurFi�cEwsc. <br /> ��ME <br /> PLU4lMIGCONTR/�GIp1 M�n�00Rf55 CIfY ZIP PIqNE ST�iF�ICENSE� <br /> coNrrucrrr�awa� �� �- � MEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> oaecrose wonK�w sou�ae r �ae�vaveo c�ucr rcnsa+um vrrorrt rio 1 � �C <br /> l_ <br /> - -1 1� �� y '� - �_ ` � , , <br /> I HEREBY CERTIFV THAT I HAVE REI1D AND E%AMINED THIS <br /> APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rrqeos[o use a e�udra PqOVI510NS OF IAWS AND ORDINANCES 60VERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> �aupEecnPrqNp�rmrEnrr�yqwne[iowon�n�cNtwocanes� NOT. THE ORIINTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ior eiou or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTNEH STATE OR LOCAL lAW REODUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TMAT I AM AUTHORIZED BV 7HE <br /> OWNER OF THIS PROPERTY T ERFORM THE WORK FOR WHICH <br /> APPIICATION E COMPLY WITH THE STATE <br /> �E��p R` CONTRIICT S UW 1 D 96.200 WAC. <br /> UO`- /� �_?/"�4 <br /> CpN91RUCT10M LONI LENOER.110dIE5S.tElE1M1d1E MI4BER X <br /> SIONATURE D�� <br /> d�'/BU91NE85lICENSE NO <br /> K,��p MECNANICAL <br /> NO. TYPE OF FlIITURE OR REM FEE NO. TYPE OF EGUIVMENT FEE <br /> WATER CLOSET(TOILET) � NC—AM11NDLa UNfT3 ' <br /> BATHTUB ' FORCED Alq SYSTEMS ' • <br /> UVATORV(WASH OASIN) i HEAT PUMP � <br /> gHpyyEq � UNIT HEATERS ' <br /> KRCHEN SIIM(8 DISP i CLOTHES DRVERS � <br /> W6HWASHER � RANGEHO00 ' <br /> LAUNDRV TR11Y � WATER HEATER i <br /> CLOTHES WASHER � WOOOSTOVE � <br /> URINAL � MtTAL FIREPLACE(WDOD BURNINO) ' <br /> DRINKINO FOUNTAIN � FIHEPLACE INSERT(VJOOD BURNIN6) � <br /> FLOOR DRAIN � OAS FIREPLACE ' <br /> BACKFLOW PREVENTERS � ��4E ' <br /> SINK(SERVICE—BAR.ETC.) � �P�P�NQ ' <br /> � E1fHAUST FAN <br /> � ' <br /> i ' <br /> � <br /> � <br /> � T <br /> SUBTOTAL f ' SUBTOTAL f i <br /> PERMIT f i PERMIT f � <br /> TOTALFEE f � TOTAIFEE t ' <br /> FOR OFFICE USE ONLY: <br /> i110NTRETO�CM REARSFTMLIt S�OEBETB�CIt �lANp1ECICNU411f11 fEF �FCfl�tNO <br /> USE IONF iot�n[� V�G1NI&TF FEES VALUIITION FEE � <br /> OVfS ❑ � BUIOM6 � <br /> NEIONT LIMIfA�ION NO 0�OWEII'1q SIiE 0�eLDORI — � <br /> � <br /> UMIIS PlI1MPINf1 — _ _ � <br /> � <br /> OCCUP�NCt NOOfSIM[5 p:CUP�NIL0�0 S�SEMENf MFCIUNICM � <br /> 0110UP — <br /> ❑YES ❑NO � <br /> FIRESPPoNKLFRREO'D Af�5p1 ��1U���ON�lP1�NC�RLM , � <br /> �_ <br /> � <br /> omrn <br /> iMEN/RMREO'D AE�SfM1 � <br /> SIAIE BItllDIN6511f1CN�fibE <br /> Y <br /> trre ov r.oasr vinNs�n�ov[oer CITY OF EVEREIT runi v wrx��s ' <br /> LOCAL SALES ' `-�— <br /> o��E TAX CODE IS �t05 toiAL � <br />