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� �. <br /> APPLICATION FOR CONSTRUCI iON PERMiT <br />� CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> f-I pEMOUTION f 1 COMBINATION BUILDINO f 1 MECHANICAL r i pLUMBING f I SIGN <br /> PROJFCT ADDRESS 7��� (,v , c /}S Inlo /L� l�Q— �� <br /> J y <br /> OWNER M�II�DDRESS CITY ZIP PNONC <br /> TFf-� (3bErniv Ca. , P� Ijox 37�� l�✓S ��-�3� S�'itT���_ �12� ZG6 -3J"E� <br /> TEN�NT M�IiR)pPFS Ctt� )Ip pr1UNE <br /> �/r/G . <br /> ARCNITCGf ORllE514N[n M�II�bOREES CItt 71P PHONF <br /> �o�(nr6. <br /> 4ENEMl CONtR�CTOfI ^ M�II��NMESS fIIY p�P p110NL GiQE IICENSF.� I <br /> > (1.0 LN`j UE�'l� I <br /> MFCN�NIC6lCONiRR /OR M�IIA�IMf.55 �pY 71P PIIONF St�iFLICFNSEi <br /> PLOMBINUCONIR�f,IOR M�ILI0URE55 dfY IIP P110NE ST�TFLICENSE� I <br /> CONIRICT PRICE Of WOfIN / — <br /> �QI 000 MEATING SYSTEM: I �GAS bfELECTRIC f I <br /> OESCRIBE VJOi1N�ND 50UAAE F00T116E INYOLVEO � Q CO i�Ci PFRSDN�ND PNONf N0 ���_���� <br /> �O <br /> 1 _ <br />� i�sT•�-w n��ic6 P�r�-�-�r'io�r�.,� L�oNA��-D �rLs�t3oR-Sk�l <br /> I � 9 6�0 ,S� I HEREBY CERTIFV THAT I HAVE READ AND EXAMWED THIS <br /> PNOPOSF.D USE OF BIIILqNO APPLICATION ANU KNOW THE SAME TO BE iFlUE AND CORRECT ALL <br /> ��f�G� 5p,t.��. PPOVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEO�LOESCNPTIONOFP110PERTY�SHOYMBELOWOR�R�CHTWOCOPIES� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�a:K _or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR IOCAL LAW REOULATINO CONSTRUCTION OR THE <br /> PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> I OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHir,H <br />� APPLICATION IS MAOE AND 1 COMPLV WITH THE STATE <br /> PARCEL T�X 10 MIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCiION IOAN LENOER.�ODlIE55,TELEI'HONE NUMflEP x �'P—�+(w�//. (��:1't� )/��� <br /> SION�IIIRE p�TE <br /> CIfY BUSINF.SS LICENSC NO <br /> PLUMBINO MECHANICAI <br /> NO. TYPE OF FlIfTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />� WATER CLOSET(TOILET) � A/C—ARINDLO UNITS—H.P. � <br /> BATHTUB ' fORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOFY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATEPS—B.T.U. M � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � VENTILATION FAN � <br /> IAUNDRY TFAV ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER �— <br /> URINAL � WOOD STOVE � <br /> 1 DRINKINO FOUNTAIN i METAL F�REPLACE(WOOD BUFNIN6) i <br />` FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINQ) <br />� BACKFLOW PREVENTERS ; GASFIREPLACE ' <br /> SINK(SEHVICE—BAR,ETC.) 6AS RANGE � <br /> I ' GAS PIPINO <br /> i E%HAUSTFAN � <br /> i i � <br /> � � <br /> � � <br /> � <br /> SUBTOTAL S SUBTOTAL S ' <br /> PERMIT S i PERMIT E � <br /> TOTALFEE S � TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> fRONT SFiP�fR Pf�R SFTfl�CI( SIUk SF'B�f.N PI�N CIIECY NUMOfR �FF f1ff.1'IPI NO <br /> IuSEior+e wrene� V�f.�Nt51tF FEES VALUATION FEE <br />� IIYES I'� NO 1,� �. / r— <br /> 011il DING �U O� �SD �S� <br />' IIEIOIITUMIT�TION NOO�IJWfLLINp 512EOfpL11GT <br /> IlNilc � � PIUMBiNfi — � <br /> _ -- _" —�—_ <br /> OCCUP�NCY N(1 d 55IOM[5 IX:CIIP�Ni IOq�U PA[E NI � <br /> (IRD � � 1 MfC111NICQ _____ __'—_ _ " <br /> II�FS �O <br /> fIRE�UIINRFO'� �F�SfNJ �OOIIIONM PI�Nf.uff.N <br /> y�s Fxs��, ---� __ <br /> mr�en <br /> ��RFsraiHricnnFon aF��c». ��/7�� /� <br /> y�S � �5� (.� sr�iE nunnwc sunuun�c _ ---! -1�LL <br /> trreorcoNsi rinNsnr �CvFnnr CITYOFEVERETT rupu[WpnKs � _ <br /> ��� LOCAL SALES --- /�5 � <br /> ---- --- - - - , <br /> V � � n.,i � � 9—S � 7� TAX CODE IS 3105 TOTAL '._ <br /> _ ____ _ _1 _. <br />