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APPLICATIt..� FOR CONlSTRUC7 .JN PERMIT <br /> C�7Y OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98261 •259•8810 <br /> ❑ DEMOLITION ❑ COMBfNAT10N O BUILDING ❑ MECHANICAL O PLUMBIN(i <br /> PROJECT ADDRESS: ❑ SIGN <br /> � / �� CdL�/ �f��F�T i�A,9ti.��/ <br /> R J MutllooNE55 <br /> � e/ �-S�hD�017 ��� ' -��/Y� nP � r'� <br /> f� � /�IRY�L�1 � 1/►�� 9��� 6,�p�'y�79 <br /> TENµT MNL4DQA[SS <br /> utv z�v p� <br /> ����CGTORDESIGNER M�nwor�ss ��n. <br /> ZIP pH�E _ <br /> /�/fCONTR� TOq M,�/�4� MIXiE55�f y/ /C.vIT1Y I�p <br /> /'/�� 1 '�1_��/(/ ^Sl�� //�� MIONE :IATE I ICCNSF� ;. <br /> n� ' ��� <br /> / tGI�ANICALGpNTR11LTOR MRII�DDRE55 ,� R�- <br /> TM z�C ��E STA1E UCENSE• �" <br /> . .�7�� <br /> PLUAbMfi CONTR�GiOR MMl�DDRE55 "�-y <br /> CIfV PHONE <br /> Z1P STATE IICENSE r . � �"' <br /> CONTMCT MMGE OF Wqi1c __`���.E�. <br /> Q ' � HEATING SYSiEM: O GAS ❑ELECTRtC ❑ ;:�`' �' <br /> � � A T _ .. :./ <br /> l � � CONTACT PERSON Aryp Pl1pHE 1q - -�... <br /> � � �� ^ - ",.�f <br /> . ,;i .•;. <br /> �� /a � � I HEREBV CEHTIFY THAT 1 HAVE REA� AND EXAMINEO THIS <br /> moro o use euadwn APPUCATION AND KNOW THE SAME TO 8E TqUE AND CARRECT ALL � <br /> � � PqOVISIOHS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OP ��'"�.�''�- <br /> lEG LDESCRIP11WpFp�ppEqry�$1pYy����py/�q�n�HTWOCO%E5) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> wt �� <br /> �' AUTHORTV� TOiVI0LA7EAOR CANCELETHnE P OVISION OF AINY •� <br /> 07HER STATE OR IOCAL UW REGUUTIN6 CpNSTRUCTION OR THE ':s N, <br /> PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHOqIZED BV iHE - <br /> ONMER OF THIS PROPERTY TO PERFORM TF+.E WORK FOR WHICH - � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> MRCEL TIUf ID.M1MBEp CONTRA RS LAW f B. RC ND 296.2tl0 WAC. <br /> / �/� — <br /> �J� <br /> �TRUCTION lO�li LEN�ER.110pf1E55.TELEPf10NE NUMBEP � � <br /> X <br /> — S ATURE D�TE <br /> CITY BU$�NE55 LICENSC NO <br /> �{��� <br /> MECMAHICAL <br /> �. TYPE OF fl1(TURE OR ITEM FEE NO. TypE pp EpUIpME�{ <br /> WATER CLOSET(TOILET) FEE <br /> ' A/C—AMNGLGUNfTS <br /> BATHTUB ' <br /> i FORCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � <br /> ' UNIT HEATERS , <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> OISHWASHER � <br /> ' RANGE HOOD "�— <br /> UUNDRY TRAY � WATER HEATER � <br /> CIOTHES WASHER � WOOD STOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOpD BURN�NG) ' <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> � <br /> BACKFLOW PREVENTERS � GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS FIPING � <br /> ' EXHAUSTFAN � <br /> � <br /> � . <br /> � <br /> � � <br /> i — <br /> SUB TOTAI S � SUB TOTAL S ' <br /> PERMIT y ' <br /> ' PERMIT f � <br /> T0IALFEE f � TOTALFEE S � <br /> KOR OFFICE USE ONLY: <br /> fRONT SETB�CI( REAq SETB�CR SIOE LETEJLN PIAN CIIEGk NUMBEIi fEF RFC[IPi NO <br /> USE20NE IOTME� V�CANf51fE FEES VALUATION FEE <br /> __ ❑YES ❑Iq <br /> HEIONT LIMITATION BWLUIN(i <br /> NQ pF�WEI.UN(1 SIZE OF BL00/f.l <br /> UNIIG <br /> PLVMBING <br /> GC�PANGY 1q pi 51(%tl[S OCCUPN/t lp�D B�SEMENT —+— <br /> MECN�NI�µ � <br /> ❑YES ❑NO <br /> FIflESPRINKLERpEp'D RF�SON �ODIIIONRPIANCNf.CN <br /> OiNER �-- <br /> FlRE NApM PEO'D RF�SpN <br /> STAi[BWtDiNC SUqClUfICE �� <br /> rrre ov r.owsr PL�NS MP40VEO BY CITY OF EVERETT ruanr,woe�s <br /> LOCAL SALES — _�,_, <br /> O�TE TAX COOE IS 3105 TOTAL J— <br />