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APPLICATI�! FOR CONSTRU�C".�ON PERMIT <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET• EVEREiT,WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION I,, ❑ BUILDING ❑ MECHANICAL [�, PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �i�� (p(yh/ ,�(,� ��Br Z <br /> OWNER � --� N�iL�p011E55 pTY Z�P PNONE <br /> \ ,� ( <br /> C�J <br /> 7ENANT Y/Jl6DOR65 GIIY )IV P110NE <br /> A11GN1tCGT OR OES�GNER M�II�ODRE55 C�IY 7m PNONE <br /> GENEMICONTReCTON MULA0DRE55 LIIv qP pIIONE SIAEIICENSEr <br /> ME ANILAICONTPA�T AqADDNE55 fITY ZIP PIIONE S7ATELICENSE• ��� <br /> �t��t�c 1�����au�icu I ��� �3 -�y'��,5� �rrK�au�98Ds3�v�� gl�a��odz�� <br /> PWMBNJCCWI7RACTqi M�ILADq1E55 ptY IIP PuONE STATEULENSE� <br /> ,{�'Z,$00,D r� <br /> C f T PRICE OF WORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIG ❑ <br /> OESCRIBE NORK AND UA FOOTAGE ED n CONUCi Pf.I150N ANO PIIONE ND <br /> ✓1 <br /> ��`a � �t �f��7 � r r� <br /> I HEREBY CEFTIFY THAT I HAVE READ A!i0 E%AMINED THIS <br /> Pf10PO5E0 USE OF BUILDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHFTHER SPECIFIED HEREIN OR <br /> lEGl1LDE5C111PT10NOFP{10PERIY�SlqNT1BElOWOR�T7/�C1ITWOCOPIES) NOT. THE ORANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> �or atocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTqUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER UF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS A E AN I COMPLY ";ITH TNE STATE <br /> PNICEL Ou(ID.MIMBER CONTRAC bS .2� d 96200 WAC. <br /> ✓ <br /> i <br /> CONSTRVCiIONLOIWLENOEP,A0p1E55,fELEPNONENUMBER x � r D <br /> SIGN�7UPE DAIE <br /> Cltt B1151NE5S LICENSL NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flIfTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE , � <br /> WATER CLOSET(TOILEn � AIC—AMNDLG UNfTS � �� - •a�� <br /> BATHTUB ; FORCED AIR SYSTEMS � I <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS � <br /> � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � RANGEHOOD � <br /> ' LAUNDRY TRAY ' WATER HEATER L � <br /> � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � ME7AL FIREPLACE(WOOD BURNING�' ' <br /> DRINKING FOUNTAIN ; F�REPLACE INSERT(WOOD DURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> ' EXHAUST FAN ' <br /> � i <br /> � � <br /> SU8 TOTAL S ; SUB TOTAL f ; <br /> PERMIT S � �oo PERMIT S � <br /> TOTAL FEE f ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FFONTSETB�CR RE�RSETBRLK 9DESE7BACk PUNGIIECkNUMffffl fEF R(CEIPINO <br /> USE ZONE l07 AHE� VAC�NI S�tE FEES VALUATION FEE <br /> ❑YES ❑HO pNl01NC � <br /> NEIGIIi LIMIT�TION HO OF DWELlINO S12E O�BIOCRI � <br /> IINIIS PLUI.IOMG i <br /> � <br /> GOUPANCY NO Of SI(MUES OCCUPANT LO�O 9�SE4ENi MFf,11nMGl � <br /> ❑YCS ❑NO — � �— <br /> FI(IESPBINNLERR[O'0 RE�SON ADDIIION�LPUNCufLN � ' <br /> _�-- <br /> OtIlEO <br /> FIREAURMREO'D FF�SVII <br /> ST�I[OUIIUINQ SIIRCIUf16E <br /> i <br /> �vreorrousr rtnNsenrnov¢oor CITYOFEVERETT runiir.wnnKs <br /> LOCAL SALES — --- --� <br /> o��E TAX CODE IS 3105 TOTAL 7 <br /> S3 ��� <br />