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APPLICATIOrI FOR CONSTRUCT�.jPi IPERMIT <br /> CITY OF EYERETT• BUILDING DIVISION � <br /> 3200 CEDAR STHEF.T• EVERETT, WA 88201 •259-BB10 <br /> C] DEMOLITION ❑ COMBIN'AT1ION O BUILD�NG MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTA�ORESS: '..�� �..7, �aS�i�v (' Us•r� ��� ��, [/S- (�� <br /> -T�- �,�C� C'or,�rNH :' � `r »� 3'�07 e.�*+� t.- P �1eIZ�J 206- z�G- 9�45� <br /> OMMER Mal� - 59 cin Im � <br /> /` PNONE <br /> �_�_\ClQ l (i <br /> ���"�'T �— 4eIlMp1E55 I /� �y fY 71P PMOME <br /> 1'f1%Q'MM��s�.) rrl'�� 12Z1 Zrd /-1VL�, 1�1'-Il� �/_,A ya0?i2 ZO�s•S�S�?W <br /> �RLMTCCTp1pE516NER MNIMpRE55 �� tl� PNONF <br /> O�EqEBeICONTMCTp1 M�IL�OURESS �ifY 71P PUON[ 5te1ElICFNSE� <br /> rtEc.��S�J C'�aP �zz� 2„� /k�,� � , �5e �r I a �{yu32 7� s,s 9,�o f�n��k2i�nl'r <br /> MELNAMW�pqTN�CTOH M4lMORESS fitt� plP P11pNE ST�TEPCENSE� �, <br /> PLU48WGLONTR�Cip1 N�iL�00nE55 prv iln PiqNE ST�1EliCENSE� <br /> GONTR�CT PRICE Oi WqIN <br /> � 10 tbo '— HEATING SYSTEM: C GAS O ELECTRIC � <br /> SCRIEE WOIIN AND$pU�RE i00 A(E W VOIVED CONTAG FEPSON�NO P E�p <br /> TuJ n-f w� i�rn, til L LEAr� �oG-s'1S-9'Iw EKr 7 P,�+, <br /> , - <br /> �(�1l� �l�oi� �it �JVr <br /> I HEREOY CEP' �FY THAT I HAVE HEAD AND E7fAMINEO TMIS <br /> vrqrouo usE oF Bwiara APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES QOVERNING TfiIS TYPE OF <br /> WOi1K WILL BE CAMPLIEO WITH YlHETHER SPECIFIED MEREIN OR <br /> lEOl1LDE5CPoPT10NpiP110PERfY�61qWNBEIOWOii�TT/iCNTYp�pPIFS) NOT. THE ORANTINO OF A PERMIT DOES NOT PRE5UME TO OIVE <br /> wr e�ocK a AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REOVLATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZEO BV THE <br /> OWNER OF THIS PROPERTY TO AERFORM THE WORK FOR WHICH <br /> I O Z�O�– I – U 02–0 UO 8 APPLICATION IS MA 1 COMPLY WITIi THE STATE <br /> PAi10El TM 1.0.MIMBER CONTRACTORS U ANO 288.200 WAC. <br /> CONSTRUCTIONIO�HlENOER.MppE51.fELEP110NENUulER x ' y��'(� <br /> SqN� RE OZU A1E <br /> Cltt NESSIICENSEHO <br /> PLUMBINO ME HANICAL <br /> NO. TYPE OF fl7(TURE OR ITEM FEE N0. TY{e OF EQUIPMENT F2E <br /> WATER CLOSET(TOILET) � NC–NHNDLO UNR9 � <br /> BATHTUB ' FORCEDAIqSVSTEMS � <br /> UVATORV(WASH BASIN) � HEAT PUMP � , <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS � <br /> DISHWASHER � RANOEHOOD �— <br /> UUNDRY TRAY ; WATER HEATER � <br /> CLOTHE9 WASHER � WOOD STOVE , <br /> URINAL � MEfAL FIREPLACE(N/OOD BURNING) � <br /> DRINKIN6 FOUNTAIN , FIREPLACE INSERT(WOOD BURNIN6) , <br /> FLOOR DRAIN � GA$FIREPLACE � <br /> BACNFLOW PREVENTEHS ; GASRANfiE � <br /> SINK(SERVICE–BAR,ETC.) GAS PIPING � <br /> ' EXHAU;T FAN <br /> � <br /> � � <br /> � � <br /> i <br /> SUB TOTAL f ' SUB TOTAL t /�? ' <br /> PERMIT S � PERMIT f �� � <br /> TOTAI FEE S � TOTAL FEE S � ' <br /> FOR OFFICE USE ONLV: <br /> i1qHTSETBACK RF�RSETBACIt S�OE6FTB�CN P�eNL11ECR MBE fFF �Ff.FIPfNO <br /> r-���� <br /> u5F iOUE l01�RE� veCu+r srt[ FEES VALUIITION FEE <br /> ❑YES O NO BUIIDMfi � <br /> i <br /> NEIONTLtMIT�TION NOO�DN'EllIHO 91lEOFlIDp/fl � <br /> UMIfS P�UMBINO i <br /> Q�`O1CY Iq d 31MEt OCCUP�NI 10�0 B�SF4ENT MECHuIIC�I i <br /> ❑YES ❑NO � <br /> FIRE6P111NKlERpEO'0 AF�90N <br /> �OqIION�I A�M CMi.CK � <br /> r <br /> O1HE11 <br /> i <br /> iIREAIMMREO'0 NF1FpN � <br /> STAIF lUIIDIN(i SIIfICN�ME i <br /> �- Y� <br /> �rv¢ar,owsr V�/.NSMPRpVEDBY CRYOFEVEREI'f ruair,woaR!� j <br /> LOCAL SALES —�— <br /> o��e TAX CODE IS 7105 TOTAL ; <br />