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APPLICATIO. . FOR CONSTRUCTI.�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> _ 3200 CEDAR STREET•EVERETT, WA ggpp� .259-8810 <br /> ❑ DEAAOLITION ❑ COMBINATION Q'�UILDIKG O MECHANIC4L ❑ PLUWIBING <br /> PRWECTADDRESS: / . / ❑ SIGN <br /> /,� /S/ �'n�5'�L-1�L <br /> °M"rt^ u�n�oon¢ss Cn. <br /> 2m PHONE i <br /> �or�a jaL�e;- /� // C'o/�,. /,�ve L3��+Ye�� lV � <br /> 'ewwr uu�mm�Ess 9.�'206 aOG ?S2 793C <br /> s 2�>e UT. 7iP P,�ONE <br /> •RLMTCCTOqpE51C.NER 1MI1�00RE55 CITY <br /> lIP PMONE <br /> �cLz�-,1 C'•,�cT �U /�o� /3 yG `.[�'/f� 4t/-�— 9�'�UG 3>O' S'�/�/-6B'Si <br /> uEr�aKconm�cta� uuiwonEss crtr <br /> "� r�KK+e SI�fELICENSE� <br /> �O N C <br /> ME�M�MGLCON7A�Cip1 MAII�ODRE55 �tt <br /> ��� P���E ST�TE LICENSE� <br /> AJON <br /> RUIlMGCp/TNA�fOR M111�ADOqESS ���. <br /> ' ��r ��E STAiELICEN$E� <br /> CONTMCT VIMCE OF N911K <br /> k�ATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> �FSo�EwdM�No REf00T� vqyED 1 cod��crr[nSVr+�NOPNpr�Erq <br /> ��C� u�� �/� rou�� <br /> .z; <br /> �J����e �,,v... � • u/ (1... �d <br /> ��U✓/✓ r.{J.�� 3� ,�?y I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN'cD THIS <br /> Pnoros�co/us¢a ew�oma �� APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> //D/J1� PROVISIONS OF UWS ANO ORDINANCEG GOVERNING TNIS TYPE OF <br /> t[oupe5cqwnor�pFp'qPERn.�Srpwr���pypq�n�M� ' WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE (3RANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot e�oac oF AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATINO CONSiRUCT10N OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHpR2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOHM TNE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE SiATE <br /> ►�iNc to,r��q CONTRACTORS LA1N 18.27 RCW AND 296.200 WAC. <br /> va�o- 3y/-oas—_000� /� <br /> cor/5mucnor��aw ieruen.�oorrtss.teiE�ar�rnn�een x %��� 1 J � a <br /> 51GNi� /- 'S^_/ <br /> D�tE <br /> CItY BVSINESS LICENSE NO <br /> �V�� MECHANICAL <br /> M�. T'.'PE OF FlIfTURt Oq ITEM FEE NO. TrpE q:Eq11pMENT <br /> _ WATER CLOSET(TOILEn �E <br /> BATHTUB � �—AMNDl0UN1TS � <br /> � FORCEDAIRSYSTEMS � <br /> IAVATORY(WASH BASIN) i NEATPUMP <br /> SMOWER � <br /> ' UNIT HEATERS , ' <br /> KITCHEN SINK 6 DISP ; CLOTHES ORYERS <br /> DISNWASMER � <br /> ' RANGE HOOp '�— <br /> • _ UUNDRY TRAV ; WATER HEqTER � <br /> CLOTHES WASHER � WOODSTOVE �— <br /> URINAL � METAL FIREPIACE(WOOD BURNING) � <br /> DRINKIN(i FOUNTAIN ; FIREPLACE INSERT�WOOD BURNING) ' <br /> FLOOR DNAIN � GAS FIREPUCE � <br /> BACKFLOW PREVENTERS ; GASHANGE � <br /> SINK(SERVICE—BAR,ETC.) ' <br /> � GAS PIPING � <br /> EXHAUSTFAN <br /> � � <br /> � � <br /> � <br /> � <br /> � � <br /> � � <br /> SUB TOTAI S � SUB TOTAL f ' <br /> PERMIT ' <br /> S ' PERMIT S � <br /> TOTAL FEE S � TOTAL FEE f � <br /> FOR OFFICE USE ONLY: <br /> �RONtSETBI�f AE�HSF.TB�CN SIDESETB�CN PlANC11GCkMILNifO fEF RfCF1PfN0 <br /> useior� �orm6� VA�ANISIfF. FEES VALUATON FEE <br /> ❑YES ❑no omirnNr. � <br /> NE�ONT UTAi�Tip/ � <br /> NO Of l'N'EL4N6 S12E OF BIDOR.I � <br /> �!N115 <br /> �II,'�pINC /�f�f�i <br /> Q�^�M�'Y NO pt SIMM[5 OCCVI'ANI LO�D B�5[4ENI �-I <br /> MfC11�4if.M � <br /> I ❑YES ❑Np � <br /> FIqESP{iINKLEqREO'D RE�SON �DUillpNel.tM�NG11fC1t i � <br /> i <br /> 0111[i � <br /> fIPENl/1MRE0'0 Rp�gpH � <br /> 51�1[OUIIUINfi SIIfIC1Uf1(7[ .L!J/I,,�)�///� <br />�. iYPEOFf,pNST Pl�HS�PPRpVEDBY — �f-r'�z-+r <br /> CITY OF EVERETT runnc wnnKs <br /> LOCAL SALES T_j_ <br /> o�ic TAX CODE IS 3105 TOTAL O � <br />