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,- <br /> APPLICATI(,rd pOR CONSTRUCT�ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> O DEMOLITION ❑ COMBINATION p BUILDING 'MECHANICAL <br /> � ❑ PLUMBING ❑ SIGN <br /> PROJECTADDHESS: ��,����„� .j � (`� ( . I� �r— G{� - <br /> �%� 1� '_7—C-.��_ I r1 L��.� <br /> OWHER MMl11DWiE55 <br /> /� ptY Im—/' <br /> �l ��l—'�-=� ��1�u1 � �1T ( 1�il,Firi-� � '��Q_111LIJ1Yr���E\I �II,�� c� ( l% t� <br /> TENI�M MM npDnF.55 � U � L <br /> ��� 1`II�N <br /> Aq[MTCCTOROQSIGNER M111t MD�E55 �------_� � _ <br /> •��' v�rOHE <br /> GE EP i�pNiR�GtOq Mqt�DpPE55/ ----' '_" <br /> cnY 11• PIIONC SUTEI� EHSE� <br /> �' � � _����-+- � 9 �>> f/'�7 � �il���lin�� � <br /> E u11C�LC m�CiWl MAII�ODnE55 �—fln. Y7ZJ� CII <br /> ��� ����E SI�fE LICENSE� <br /> PIVMEINGCONTR�TOR YNLApppE55 � � CIIY --- -"—" <br /> trv PI'ONE <br /> /�� � $TATE UCENSE� <br /> fANiiUCT VRICE OF <br /> - - � ��'J — NEATING SYSTEM: GAS ❑ ELECTRIC 0 <br /> OESCRilE NV11K�Np 5q)�RE LppT�GE MVOLVED --�--- <br /> CONV(:�pfOSpH�NDP11pNENp � . / II� <br /> y �ri, �;�_ <br /> 'C; lJ �� ��C.A '�1c 1- _ i�i � ���) <br /> I NEREDY CERTIFY TNAT I HAVE READ AND E%AMINED 7HIS <br /> nnovos[o use ov em�pr.a APPLICA17pN AND HNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGKOESCNIPTIONpFppq�qry(gHpWryBELOWpR�71/�CMTNpCOPIES) WORK WILL DE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE Of1ANTIN6 OF A PERMIT pOES NOT PqESUME TO GIVE <br /> ��T BLOC� a AUTIIORITY TO YiOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW pEGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTqUCTION.THAT I AM AUTHORIZEO BV THE <br /> OWNER OF THIS PROPERTV TU PERFORM THE WORK FOR WHICH <br /> APPLICATION IS DE AND 1 COMPLY WITH THE STATE <br /> PMCELTNlID.MJMBER CONTHACTOR AWiB. D296200WAC. <br /> CaN5T111GT10NlO�u1lEN0ER.�0onE5S.TElEPMONENUM9(� � �� <br /> X� <br /> 516N�1 qF. D�TE <br /> CI IY IIII.i1Nf:S51 M:fNSE NO <br /> PIUNBINO <br /> MECIIANICAL <br /> �• TYPE OF flXTURE OR ITEM FEE HO. iVPE OF EOUIPMENT <br /> WA7ER CLOSET(TOILET) --' --- FEE <br /> BATH7U8 � NC—M1NDL(i UNfTS , <br /> UVATORY(WASH BASIN) ' _ FOf1f,ED AIR SYSTEMS � <br /> SHOWER ' I IEAT PUMP <br /> KITCHEN SINK 8 OISP � UIJI i I1EAiERS � <br /> � CLOTHES DRYERS <br /> DISHWASHER � RANGE HOOD � <br /> i <br /> _ UNDRY THAY ; WATER IIEATER <br /> CLOTHES WASHER WOO�STOVE � <br /> � <br /> UHINAL � <br /> ' Mf fA(.FIAEPLACE(WOOD BURNING) � <br /> DHINKING FOUNTAIN FIREPLACE INSERT�WOOD BURNING) ' <br /> ROOR DRAtN � — � <br /> ' GASFIRfPLACE �— <br /> BACKFLOW PREVENTERS — ' <br /> _�_ GAS RANCaE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> EXIIAUST FAN , <br /> � — <br /> � <br /> � <br /> � <br /> i — ' <br /> � � <br /> -- -- � <br /> SUB TOTAI S � SUB TOTAL f 5 � <br /> PERMIT f � PERMIT 5 � � <br /> TOTAL FEE f � TOTAL FEE f � <br /> FOR OFFICE USE ONLY: <br /> �RONTSETBALK PE�PSETBQK SIDESEiB�CN PI�NCIICCItN1161pf11 fCF RFCEIPTNO <br /> USEZONE IOTAREA V�CANfSIIE FEES /� VALUATION <br /> ❑YE5 — FEE <br /> �� ❑ NO OUI1b1116 —�i —_ <br /> MEICNi 11MITATION NO OF OWEILING 54E OF BIOGRI i <br /> VNIiS <br /> PI UM11Mfi � <br /> i <br /> a��MCY MO M SIMIIFS OCCUPANI LO�D OASEMENi --�— <br /> MECI1�NIf.e1 <br /> ❑Yf5 ❑N7 �--� � <br /> flRESPpINKLEpNEOD tIF�SON �OUI�IONN PI�NC�Iff.N � <br /> r <br /> �-- <br /> FIREAURMqEO'D PE�SON ����Cn � <br /> � <br /> StAIP fllllllllllft:Illlf.11�lt(}C i <br /> TYPE OFf,pN57 PLANS�PPqOVE00Y ' i— <br /> C17Y OF EVERETT rum ir.wrn�nc <br /> LOCAL SALES -- --- _ __;_ <br /> D�IE TAX CODE�S 9105 TOTAL � <br /> . . _ . _�___— .. _ _ _�.�.." ' J� <br />