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APPLICATIC .J FOR CONSTRUCT�'�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION p COM8INATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJ�CT ADDRESS: � �'}'I -. �(�' <br /> .�'.xmEp M�IL�OpiE55 cin zm rnor2 <br /> �r���� �:�P '; 1 � � � C . .�`- . . ��:c-�i� �{ � ��[ ��(`(i� 2 �5 ' �.2'�.`� <br /> IEN�NT MNLMIpHESS ry,ry ��p �,���E <br /> �RLMTCCTpiDE51GNFA IIIIDURE55 'f�ITY `,` )IP PNONF. <br /> �¢.,ti1 �� -.����. �i1�'1< S� �1'�. �� �r-aTtt� 1A -�-�.Q��� �"�C�l--� ' �9 " � ��` 5 <br /> GENEiV4GONiR�CiOR Mu�ApDRE GITy 71P P�I N[ SI�TCIIG[NSE� <br /> MELHANICµtpNTR�CTOR M�IIADpiE55 CIIY )IP PIIONE 5111TEUCENSE• <br /> PIUMBMGLONfRAGTOR Ml�I��ppRE55 GIfY jIP PIqNE S�AIEIICENSE• <br /> GON�MCf PR1LE OF VIORK G� <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> D�SCMBE YN11K�HD Sq1ARE FOOTIICE IN OLVED � GONiAGI f`Cn50N AND PNONE!q <br /> � - � � <br /> ` , . <br /> 1 <br /> ! � l 1 <br /> , '� .1_ ( ' - ' !� ' V I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMMED THIS <br /> oeavosEo usa a em ����/ APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> PROVISIONS OF UWS AND OPDINANCES GOVERNING THIS TYPE OF � <br /> WORK WIIL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> LElL1LDESCPoPTqNOFPfqPEqry�$�pyyN9E�pyypqATT/�LNTNqCOPIES� NOT. THE (iRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT eiocK a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTFIER STATE OR LOCAL LAW REGUUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PNpEI TNf I.D.M1IABER CONTRACTORS LAW 10.27 RCW AND 296.200 WqC. <br /> CONSTRUCTIpIIOM!LENDER.AOdiE55.TELEVIIONEMINRER X���+���� ��1� 1�)_((�'l <br /> SIGN11TU11E � 'l '1 <br /> OATE <br /> pfY BUSINESS IICENSC NO <br /> P�V�� MECHIINICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TiTE OF EQUIPMEIR FEE <br /> � WATER CLOSET(TOILEn + NC—AhiNDLG UNITS � <br /> BATHTUB � FORCEDAIR SYSTEMS � <br /> UVATORY(WASH BASIN) � HEA7 PUMP , <br /> SHOWER � UNITHCATERS � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOU <br /> LAUNDRY TRAY ; WATEq HEATER � <br /> CLOTHES WASHEH � WOODSTOVE , <br /> URINAL � METAL FIREPLACE(WOOD BURNINGj � <br /> DRINHING FOUNTAIN i FIREPLACE INSERTpNOOD BURNING) ; <br /> FLOOH ORAIN � GAS FIREPLACE —�— <br /> BACKFIOW PREVENTERS � GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> ' EXHAUSTFAN <br /> � ; <br /> � , <br /> � <br /> � <br /> � , <br /> SUB TOTAL S ; SUB TOTAL f ' <br /> PERMIT S i PERMIT S �— <br /> TOTALFEE S � TOTALFEE f <br /> FOR OFFICE USE ONLY: <br /> FRONTSETRACK RE�flSETBACN SI�SfTBACM PtANC11EGRNUAlAfO fEF REC.`iPTNO <br /> VSEIONE tot�nen yA��Nf51fE FEES VALUATION FEE <br /> ❑YES ❑NO OIIItDIN6 � <br /> NEI611iLIMITJIT10N NO pFpW[�pNG SREOFBlD6R1 <br /> UNII$ P�VMOIN6 <br /> OCCVP�NCY Iq(ItSi(Mq5 OGCUP�NTIO�D B�SEMENI -- I <br /> GRWP MEGIInNIf.M � <br /> ❑YES ❑NO — — <br /> FIRESPRINKIEflREOD REASON �DDIIION�LPUNCi�fCM � <br /> _—�__ <br /> amrn I <br /> FlREAUpMREO'D RF��fN1 <br /> S7�iB BU�IDINO SIIn��UtIGE ' /'� <br /> �� i <br /> irveo�r.or+sr rinNserrnovEnor CITYOFEVERETT runnr.wnnns <br /> LOCAL SALES — ----- — --1— <br /> o�it TAX CODE IS 3105 TOTAL ) <br />