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APPLICATIO�1 Ft?R CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREE7• EVERETT, WA 98201 •259-8810 <br /> �l DEMOUTION fl COMBINATION fl BUILDINa rl MECHANICAL � 1 PLUMBING f 1 SI(iN <br /> PROJECT ADDRESS <br /> ��� �> �N [�.p_`,/,,/n ��. ���..._ (f O 2� <br /> OVMFR MML�D011ESS CITY iIP PIIONE <br /> ,Q•�L��ni ��,, � j?o, /ne- �7,�� /'^� !7y_;��5�-ArrL� a�/�, yd�>,�,� 3`i7. -733) <br /> � <br /> IEN�NT/'f � MqUb0i1F55 ' GTV tIP P�qNE <br /> /JA�.//JG . , <br /> 1111CHI1ECTORpE51UNEA M�II�IHIf1E55 CITV 71� PIIpNF I <br /> EVG�',s/.�N rv!n/.;il_� <br /> aer.�nucowrr�cron uui�oonEss � urv --r r��oruE surEiicrNse. <br /> MEf.4�NIC�I G(NJTR�CTOfI M�It ADqiF.55 piV )if PIIONE ST4TF UCF.NSF.� <br /> MIIMBINaCONTR�f.TO{i M�ILQIDRE55 CItV IIP PnpNE Si�iEIICFNSEr <br /> CONTMCTPPoCE O(Wqlk <br /> HEATING SYSTEM: I 1 GAS � I ELECTRIC f l <br /> UESCPiBE WORR�NO SOU�RE FOOUOE INVOWED CONTQT PERSON�ND PHONF.Np <br /> ��'L�cnT'Lr T///"(_d l..i�Q� T�/�i1.6� �l;`clniil�.ri ��'(:-1'''i,�;'A,!•�,� .�(,�- 3S�? <br /> �4, X �(o � O G �F I HEREBV CERTIFV THAT I HAVE READ AND EXAMINEO THIS <br /> vnoroseo usE oF aimwr+n APPUCATION AND KNOW THE SAME 70 BE TRUE AND CORRECT ALL <br /> �TA�L Sn�S PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS TYPE OF <br /> WORK WILL BE CnMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> LEO�lOESCPoPTIQVO�P{IOPFRTY�SIqWNBElOW011�TT/�CNTWOCOPIE51 NOT. THE ORANTINO OF A PERMIT DOES NqT PRESUME TO 61VE <br /> �ot e�acK or_ AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHEH STATE OR LOCAL LAW REQULATINO CONSTRUi:fION OR tHE <br /> PERFOHMANCE OF CONSTRUCTION.TNAT I AM AUTHORIZEO BV THE <br /> OWNER OF THIS PHOPERTY TO PERFOHM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STA?E <br /> PMCEI TNf 1 D.IKIMBER CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br /> CONSTRIICTONLOANIENDEI1.�Od1E59,7E1EA10NENUAIBER x����� C.•��^'�"' y'l ^ e��j /y1� <br /> SION�TURE d O�TE <br /> CITY BUSINE55 LICENSC NO <br /> PLUMMNO MECNANICAL <br /> NO. TYPE OF FlKTURE OR ITEM FEE N0. TYPE OF EWIIPMENT FEE <br /> WATERCLOSET(TOILET) � NC—AMNDLOUNITS—H.P, ' <br /> BATHTUB ' FORCED AIR SYSTEMS—B.LU. M E.A. ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP i CLOTHES DRVERS i <br /> � � DISHWASHER � VENTILATION FAN � <br /> i LAUNDRYTRAY ; RANOEHOOD � <br /> CLOTHES WASHER � WATEH HEATEk T <br /> URINAL ; WOOD STOVE ' <br /> �91NKIN0 FOUNTAIN � METAL FIREPLACE(VJOOD BURNINO) i <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNIN6) � <br /> BACKFLOW PREVENTERS ; �AS FIREPLACE � <br /> SINK(SEHVICE—BAq,ETC.) � OAS RANaE � <br /> ' dAS PIPINO ' <br /> r E%HAUSTFAN � <br /> , � <br /> � � - <br /> i _ <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S � TOTALFEE f ' <br /> FOR OFFICE USE ONLV: <br /> f110NT RFTp�CI( PCAfi SFTBACI( SIOE SETP�C1t PUN CI�iCN flFR fFf RFf.FIPi N0 <br /> �'S�� - <br /> U&EZONE iarea[� vec�Nisrv FEE6 VALUATION PEE <br /> —_T_'_ <br /> IiYES IINO ppll0iN6 1 <br /> i <br /> IIEIOIIi UMIi�710N NO OF OWELlINO SIZE Of PIOGR I i <br /> IINIfS �� PLIIMBM6 i <br /> �O/CP — <br /> OCWPANCY NO 0�51(MXES OCCUP�NI LO�p B�SEMENT MFCII�NIC�I. � <br /> . � I1YES �NO ' — i -- <br /> REhL M OP �F�SON �f10�IlON�1 Pl�NC11/f,N i <br /> __i_— <br /> a7 Ol!1F� i <br /> FIRESP01 IERIIF.OD AF�S <br /> \ � � � ST�iE flUIlUMO SIII1f,lUf16F —_ ---! <br /> TrvecK,r, tr rinNs�rrn ev CRYOFEVERETT rum�cvmn.s __ _ ; <br /> /� LOCAL SALES —�— <br /> ��„�E TAX CODE IS 3105 iOiAL � <br /> ___1_ <br />� <br />