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APPLICATiI N FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVEFiETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDINO O ME�C/,H�AN�I AL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: ,��('�, ('� nI t'! �2 /. ��� ��7 '��7/r <br /> ,���.Q�"Q�1 ���1 l lw � �(.V'�r � �� �LJ 1 ��J Q V� <br /> MA�L�Op1E55 �yry Z1r�—"PN <br /> TEIUHT C o4 O e �'1� . <br /> MNll10d1E55 G7Y '� �� <br /> � � <br /> ; � ' �2 <br /> MCMTEGTOqDESIGNER MNI�DOpE55 CITY ZIP �HONE <br /> -T1. M h c+ ►. (° i.t� �T. 6 � �iT�' � �.n �� S• `i-�� � � .t�C1"L P L��, ,r h i <br /> 6ENENAICONTR�GT0i1 MNL�DORE55 ❑fY l�p PIIONE i11UEIICEYSE• <br /> �-lcz►-l�,tiG,ti f n►-p ► �a � � it,�� .Q �� K.�h7�tS�32 �� S��,n� tl2Tf <br /> MF�y�C�CpNTRA�TOR M�II�DDR �$ �ITY ZIV PIIONE 5TI1TE UCENSE� <br /> � � , <br /> iU, M1GCpHTRl1�T0{i M�IIADqiE55 CIfY 11P PHONE $TATEIICENSE� <br /> cat/ n�cT wncE oF wonK �— <br /> �j �l oZ(� I HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> oEscnroE wora�No sau�r� ooTk.�mvaveo CpJTACT PEHSON N!0 PIIONE NO <br /> �y 151 1c <br /> , <br /> ' � .5�,S-�'loC� <br /> � ��.i-^4t.�.p�.5 F- T S I HEREBY CEflTIFY THAT I HhVE READ AND E%AININED THIS <br /> viaroseo ust oF e�n�prro APPLICATION AND KNCW THE SAME TO BE TRUE AND C��RRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iec��oescairriar�ovmoaenrris�pwNeE�pwp��nacNtNpcppies� �MORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE ORANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT B�OCK oF AUTHORITY TO VIOLATE OR CANCCL THE PROVISIUN Of ANY <br /> OTHER STATE OR LOGLL LAW REGULl�TIN6 CONSTHUCTION OH THE ,I� <br /> � � � PERFORMANCE OF CON�TRUCTION.THAT I AM AUTHORIZED BY THE i �,;�;,y� <br /> OWNEH OF THIS PROF�RTV TO PERFORM THE WORK FOR WHICH � —Tm <br /> AFPLICATION IS MADE AND I COMPLY WITIi THE STATE <br /> PMCEL TAtf I.D.NUMBER CONTRACTORS LAW 182)RCW AND 296.200 WAC. <br /> CONSTRI/GTIUNLOANLENDER.�DORESS.TELEP110NENUMBEP x�'�(� tl ! ����L17 �jp[/^/ �7/ <br /> SIGM�P.� � D�TE �� �d I <br /> CITY BUSINESS LICENeE NO <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF Fll(TURE OR ITEM FEE KO. TYPE OF EOUIPMENT FEE <br /> _ WATER CLOSET(TOILEn � A/C—AMNDLO UNfT'S � <br /> BATHTUB ' F'ORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � IiEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> � KITCHEN SIiJK 6 DISP � CLOTHES ORYERS ; <br /> DISHWASHER � RANGE HOOD , <br /> LAUNDRY TRAY � �yA�R H��R � <br /> � <br /> CLpTHES WASHER � WOODSTOVE � <br /> UHINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> _ DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) ; <br /> RQf:R DRAIN � GAS FIREPLACE � <br /> BACKFI.OW PREVENTERS ; GASRANGE � <br /> i <br /> 61NK(SERVICE—BAR.ETC.) � GAS pIPING , <br /> ' EXHAUST FAN � <br /> � <br /> � , <br /> i � <br /> � , <br /> � , <br /> � I , <br /> SUB TOTAL S ' SUB TOTAI t Ll � <br /> PERMIT S � PERMIT S � <br /> __ TOTALFEE S � TOTALFEE S � <br /> FOFI O��FICE USE ONLY: <br /> �ROI�TSEtFdG1( REARSETB�CN SIpE5FT8+1Gk PLANp1ECKNUAIBER iEF RECEIPTNO <br /> I� <br /> USEzonE iOt�pE� v�C�NiSitE FEES VALUATION FEE <br /> ❑YES ❑No ounorc�n I <br /> NEIGNT LIMIUTION NO OF DWELIIIq SIIE OF BLONI.1 � <br /> UNIfS � <br /> FIUMBING <br /> � <br /> G�ANLY Np Of SIMIIFS OCCUPANT LO�U BASEMENf MECN�NIL�L I <br /> ❑YES ❑NO � <br /> � <br /> FlRESPN!NKLEflflEO'D RE�SON �OD410NALPLANC��f.CK � <br /> i <br /> 011�ER i <br /> ALMMHEO'D RE�SON <br /> i <br /> S1AE BWIDINf SIIRCM�OGE � <br /> TYPEOLf,ONST �lANSMPRpVEDOY CITVOFEVERETT �IIBIif,WOPKS <br /> LOCAL SALES — --%— <br /> o�ie TAX CODE IS 3105 TOTAL ; <br />� <br />