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.-. <br /> APPLICAT�L.� FOR CONSTRUC7 .J�1 PERMIT <br /> CITY OF EVEHETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT,WA 98201 •259-8810 <br /> p DEMOLITION ❑ COMBIItATION p BUIIDING ❑ MECHANICAL ❑ PLU6181NG ❑ SIGN <br /> PROJECT ADDRESS: ,��/'I ��-(�c,y- �G4'-{,�+� <br /> OWqER '/M1UL/�OORE55 /� Cltt 21� pNpN[ <br /> ��/1 fUS�t� fS l(/��C(/�. 3�?�? 3 L'[J(�.. �L4' 41 f/ 1� D/ �5 Y-� C�✓�- <br /> TEIUNT MNtA00FlE55 GiY 7�P PIqH[ <br /> •RCMTCGTOROESIGMER M1IM1IIOOAE55 CITY TIP PHONF <br /> GE N Cp1TR�CTOR MNL SS CrtY z�r � rnone GI�TE IICENSE� <br /> ����l�l��`n �� ��2�� ����-U,��o� )1�. /I�/J�i��yi/� 9G�7o l./�-,e�s,�,��9G!�3 <br /> �1ECN�N�WICONiRI1CTpi MIuI�DOnE GTY I�P f PRON[ St�iEtiCENSE� <br /> ��%-D�75 <br /> RUMBMGCpITq�CTOR MMlA00i1E55 G1Y ZIP P1qNE STATELICEHSEI <br /> CONTMCT NMCE Of NKMiK <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OESCfIIlE WVplf�NO SOU�RE FOOid(iE MVOIVED LON7�CT VERSON N1UPM7HE NO <br /> /' LLr�� ��� <br /> I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED TNIS <br /> �o����� APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT ALL <br /> PROVISIONS OF UWS AND ORDINIINCES GOVERNING'�HIS TYPE OF <br /> WORK WILL BE CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �a�o�sc�wrqr+a°r+or�Rriaarm°Eiaw°R�n"�Mnvoco�s� NOT. THE 6RANTIN6 OF A PERMIT DOES NOt' PRESUME TO GIVE <br /> tor e�opc oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATINO CONSTAUCTION OR THE <br /> PERFOHMANCE OF CANSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS P'90PERTY TO PERFORM TME WORK FOR WHICH <br /> APPLIC�TION IS MAOE AND I COMPLY WITH THE STATE <br /> rw��ra i.o.Ma.Acn CONTRAC�TORS LAW iB27 RCW AND 296.200 WAC. <br /> / �; /' /////�c�/[ / <br /> CONSTRIICTIONIONiLENOER.l10d1E55.TE1EP11011EM1M0EN « / ��K: [{"fZ•�/ .'7 /LL��/ ��S/� <br /> SIONATURE / D�tE � <br /> ptt BUSINESS LICENSE NO <br /> KV�� MECMA/ACAL <br /> NO. TYPE OF fl1IT'URE OII tTEM FEE NO. TIPE OF EOUIVMFM FEE <br /> WA7ER CIOSET(TOILEn � �_�aQ�� , <br /> BATHTUB ' FORCED AIR SVSTEMS � <br /> UVATORV(WASH BASIN) � HEAT PUMP , <br /> SNOWER ' UNIT HEIITERS � <br /> KITCMEN SINK 8 DISP � CLOTHES DRVERS ; <br /> DISHWASNER � RANGE HOOD <br /> LAUNORY TRAV ; WATER HEATER ' <br /> CIOTMES WASHEA � WOODSTOVE � <br /> URINAL � MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> IXHAUSTFAN <br /> � � <br /> -,— <br /> � , <br /> � � <br /> � � <br /> SUB TOTAL S � SUB TOTAL f ' <br /> PERMIT S � PERMIT t � <br /> TOTALFEE f � TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> fHON75EiB11CK PE�RSETBACN SIOESETB�CI( ('l�NC11ECKNUMBEp fEF REf.EIPiNO <br /> usEzor� torer�� WC�Nf51iE FEES VALUATION FEE <br /> ❑VES ❑ MO BUILOINC 2 � • � <br /> HE�OHT UWTAiION NO OF DYIEIIIfq 512E Or BLIXiRI � <br /> UNiiS <br /> PtpM01NG <br /> ��NL� MO(%S�MiFS OCCUP�NIIO�D BASEMENT i <br /> MECNI1MCl1l � <br /> ❑YES ❑NO - � - � <br /> � <br /> FIRE6PpIM(LEqpEO'0 AE�SON e0D1IlON��PUN�NECr � <br /> � <br /> 0111Ef1 <br /> FlREiW1RMRE0'0 RFASpN <br /> StAI[BU�ID�NC SUfiCHMipE — L i� <br /> r <br /> Trre ov r.or�st oUNS errqOVEO Br CITY OF EVERETT ruei�r.wonKs <br /> LOCAI SALES --� <br /> o�TE TA%CODE IS 3105 TOTAL I �' <br />