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APPLICAT"10.. FOR CONSTRUCT� �N PERMIT <br /> CITY OF EVEREIT•BUILDING DIVISION � <br /> 3200 CEDAR STqECT•EVERETT,WA 98201 •259-88/0 <br /> ❑ DEAAOLITION O COMBINATION O BUILDING MECHAHICAL p PLUMaING ❑ SIGN <br /> PROJECT ADDRESS•B/�S� /�`'�f/c' �/Q,�j� � <br /> �"'E�✓tii✓ ANO£<'JOn/ Bia !/����,�jp�f �,� 9BZ�3 /?a6J S SSS 9 <br /> OWpER MMI�pORE55 ptt ZIP p�yE <br /> TENIINT MML�bpfiC55 GlY 71P pq� <br /> �HLNITECTOi1DE51GNER MMI/�ODRE55 LITy 71� ��E <br /> GENERµ('prytMGTOR MNL�ODnC55 LrtY 7�P f§1pNE iU11EUCCNSE• <br /> C l� 2 <br /> MECHI1MC11L CON7RA�TOR M�Ul11DppE55 CATY Z�� PHpt�[ ST�TE LILENSE� <br /> PIUMBMG CONip11GTp1 MM11100RE5S GT' Z�P P1qNE ST�TE ULFN$E� <br /> fAN�PKT PpI�E a Wpry� <br /> �00 � HEATING SYSTEM: (3�(GAS ❑ ELECTRIC ❑ <br /> OESCM�E WORK�NO Sq1ARE FOpT114E M/VOLVED CONT�Gi P[RSONNID�IIpNE NO <br /> ONU i�i iy . � , O t <br /> ' L✓q i fC£CT ,q <br /> � I HEFEBY CERTIFY THAT I HAVE READ AND EKAMINED THIS <br /> vnoroseo us¢oF eu��qrq APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> PROV�SIONS OF LAWS AND ORDINANCE�GOVERNING TMIS TYPE OF <br /> �6µ���T�OMa�7�OPERTY(SNOWMBEIOWORATT/�CHTWOCpPIE51 WORK WIIL BE COMPUED WiTH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE 6RANTIN(3 OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �m et�K a AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL L�W REGULATIN6 CANSTRUCTION OR THE <br /> PERFORMANCE OF CONSTpUCTION.THAT I AM AUTHpRIZED BV THE <br /> OWNER OF THIS PROPEFTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> nwce�vuc i.o,remieEn CA^NTRACiOR�18.27 RCW AND 296200 WAC. <br /> CANSi11VLTQ/IOAN LEN�EN.MD{1E55.TElEf4q/lE NUMBEA 1ll�J/�' �/� 7 -C/ <br /> l � � (�n <br /> SIGNRURE DI1TE <br /> CITY BUSINES$LICENSE NO I <br /> ���� MECHIINICAL <br /> M�• TYPE OF FlXTURE OR IiEM FEE NO. TYPE OF EpNPME1/f FEE <br /> WATER CIOSET(TOILEI7 � NC—AMNDLO UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) ' <br /> � HEATPUMP � <br /> SHOWER � UNITHEATERS i <br /> KITCHEN SINK 6 DISP ; CLOTHES DRVERS � <br /> DISHWASHER � RANGE HOOD , <br /> UUNDRY TRAV � WATER HEATEfl <br /> CLOTHES WASHEH � WOODSTOVE , <br /> URINAL � MEfAL FIREPIACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DFAIN � GAS FIREPLACE ---'— <br /> 6ACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAF,ETC.) � GAS PIPING , <br /> ' EXHAUSTFAN <br /> _ � <br /> � — <br /> i <br /> i <br /> � <br /> SUB TOTAL S ' SUB TOTAL S <br /> PERMIT f � PEFMIT S , x) � <br /> TOTAL FEE f � TOTAL FEE S ��)G <br /> FOR OFFICE USE ONLY: % � <br /> FqONi SETq�LR RE�R SiTB/�LN 90E SETB�CM 1'L�N CIIEGR NUMB[II fCF RFCFIPi N0 <br /> USE IONE ioi�nen veCrnr sne FEES VALUATION FEE <br /> ❑YES ❑NO <br /> OUIIOINC � <br /> t <br /> HEIGIIT UMIT�TION NO Of OWEWNO SIiE Of BLOG/I.I � <br /> UNqS <br /> PlUM01NG � <br /> OCCUPANGY Iq(1[5�(NnES OCCUP�N1�0�0 BASEMEN7 � <br /> GROUP MlCN�NIUL <br /> ❑YES ❑YD - <br /> fIRESPflIM(I.ERREO'U RFASON ADDIfIONA�I'I�NC�2Ck � <br /> �i---- <br /> Ob�ER <br /> FIREMMMREOD NE�SON <br /> ST�I[DW101H6511�CNl1pGE <br /> Trreorr,ows� rinNS��rnovEoer CITYOFEVERETT r�ipiir.vmnKS � <br /> LOCAL SALES — � —�— <br /> o.Te TAX CODE IS 3105 70TAL <br />