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APPLICA7'IGr! FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•BB10 <br /> fl DEMOLITION f I COMBINATION NT BUILDINO fl MECHANICAL " PLUMBING f I SIGN <br /> PROJECT ADDRESS <br /> 3n� Gv c�-s���� �_�. �Fo -yl3 <br /> awr+en M�ILI100i1F.55 citr I�r mmvc <br /> ll�'E f3���Us Cn . p, o. Qc�' �707� S�A1T(.E' GvA . �/ 2�f 26� -3r-63 <br /> IEN�{N�T� M�IL�f%Mf55 CITv 71P 1'��ONF <br /> IX��/n/G' . _ — <br /> �RGNITCCTOROF.SIGNEf1 M�II �DDRE55 LiTY 7i� ���ONF <br /> i30 r��i✓G _ — <br /> oEr+Ei�n.corvmecron uen�nyn[ss crtv nr ruor+r swe ucrNse. <br /> Off(Lr_LR-y (7Ef�n/ — <br /> MECH�NIC�I.f.ONiR11C OR M�II�OI1RF55 GTV 71P P��ONf STA1F UCFNGF� <br /> PIIIMB�NQ LONiRM,IOR M�II�UDf1E55 Q�Y 71" PIIONE $TAtF.LICENSE� <br /> f.ONiR�CT PRICE OI MR1f11( <br /> �OnC� HE/�i1NG SYSTEM: f �GAS � 1 ELECTRIC f l___ <br /> DESCf11flE WORR�NO$OVARE fOOT�GE INVOLVED CC J1�GT PFRSON�Np f'110NF NO <br /> /Et�ni,4rz�)�STLrn�Qo/lS� ����:�. <br /> �CGft/G� /r��/1/LR.-(�N�iLrlu�+ ^�T I HEREBV CERTIFV THAT I HAVE READ AND E%AMWED TNIS <br /> - APPLICAiION AND KNOW 1HE SAME TO BE TRUE AN�CORRECT ALL <br /> vaoroseo use ov em�duo PROVISIONS OF LAWS AND ORDIN4NCES GOVERNING THIS TVPF OF <br /> O�f%/G U WORK WIIL BE COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br /> IEO�LDESGPIPTIONOFMqPERTYISNOWNBELVNOR�TT�GNTWOCO1ME51 NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> iot a�ocK _or _ AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL lAW REGUL4TIN0 CONSTHUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION."HAT I AM AUTHORIZED BV THE <br /> OWNER OF THI.i PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITN THE STATE <br /> pu�c[�uM i o nuueen -- CONTRACTORS LAW 1B.21 RCW AND 298200 WAC. <br /> CON�iRUCTION lOAN lENOEq.�fNff1E55.TFlFP110NE NUMPkR x �� `�/ _ <br /> 5 TURF. D�TE <br /> CITY PUSMEhSIICENSC NO <br /> PLUMBINO MECHANICAI. _, <br /> NO. TYPE OF Fl%TURE OR ITEM FEE NO. TVPE OP ECUIPMENT FEF <br /> --r- <br /> WATERCLOSET�TOILET) � /VC—AMNDLOUNfTS—H.F. ' _ <br /> BATHTUB _ ; FORCED AIR SYSTEMS—B T.U. M E.A. � <br /> LnVATORV(WASH BASIN) � HEA7 PUMP � <br /> SHOWER � UNITHEA7ERS—B.T.U. M ' <br /> KITCHEN SINK 6 D�SP � CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNORVTRAV � � RANOEHOOD i <br /> CIOTHES WASHER � WATER HEATER ' I <br /> URINAL WOOG STOVE ' , <br /> DRINHII�O FOUNTAIN METAL FIREPLACE(WOOD BURNING) �_ ; <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURNINp) . <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � ' <br /> SINN(SFRVICE—BAR,ETC.) GAS RANGE <br /> QAS PIPINO � <br /> �— <br /> � EXHAUS7FAN � <br /> i <br /> SUB?OTAL S <br /> i SUB TOTAL S � <br /> PERMIT S � _ PERMIT S � <br /> TOTALFEE S ' TOTALFEE E ' <br /> FOR OFFICE USE ONLY: <br /> rarwtScrr�cK nr�n�Frn�cK sioesEtn�cK r��r�c�iFCKnuunrn rrr nFcrmiNo <br /> u5E1a+F �or�nr� wcemsuF 1�= VALUATION FEE T_ <br /> iivFS ��� �n nuuniHr �V ____1_1—LX1 <br /> 11EI6�R UMR�TION Nu Or UwEIIINo si1E or AIfIOT — <br /> IINi15 / 1 �O pIUMOMO ____ _____._�_ <br /> !. <br /> OCGUI`�N(:Y 110�S��FS IX:CIIP�NI LO�O P�SEMENt -- — -- � <br /> MFOUNICGI � <br /> I9 ��.ES /� i <br /> rineeununron nrsso. �nwiroHAi neac��rcK _ . _ <br /> — — ---�-- <br /> �/�S ��srG s�S�r• on�rn I <br /> rmrsrmNKiFnneon nr��rn �/� <br /> -----'-- <br /> ✓[' S �LXsf(,. �' YS�FM srarPunoiNasunr.�unae ______ __—�._:..LCl <br /> _iS ' <br /> tvrForr.c»+st rinHsernovvnnr CITYOFEVERETI' r��n����n�s <br /> . / � f R�i LOCAL SALES — — - ---�-- -�-��---�- — — <br /> V „p�F 7- 1�� . } � � TAX CODE IS�105 TOTAL _ ___ <br />