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APPLIC,ATIO . FOR CONSTRI)CTI.�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREEl'•EVEREIT,WA 98201 •259•8810 <br /> ❑ DEMOLITION pQ COMBINATION � BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: 3J.�LF1 1'.pLbU I�l) ��, .UQr���w ��?G� <br /> Eq Met1.�ODnE55 f,itt bP P110NE <br /> �oba 11- ( nves�mc ��� � , � I � .0 ,�'� Fr�x �t�P , Fver �} ���w 987�0� z5z-�I(��- <br /> TEN�Ni ��ILAppPC55 CITY IIP MIO <br /> ARC111TCCT OA�ES�GNEF M�II�DDRE55 GiY 7�� �MONE <br /> �xq.�► �nYYUi�C �--�II 15�H 1�vc Nfi S,ea�s l� 9811� 57-1n- `i9310 <br /> GE MlG 1 G10f1 M��L�ODRC55 CIIY Ii� P�IONE 5f�1ELICENSE• <br /> �P �c� �tiu�,era I9�li�l ia�tti N�� s.ca�t�4 �.�w 9RI�� °I9�1 -�8�3 NRNf��� ��13oP <br /> MECH�NiC�tCONTR�CTOR �iUDDRE55 CITY ZIP P110NE .SiAT IICENSE� <br /> 21J !o <br /> PLUMBMGCONiF�Gip1 M�IL�DDRE55 CIfY 21P PNOHE STAfEIICENSE� <br /> �r� m< r��rn�ral <br /> °ON���p�jytiD�� HEATING SYSTEM: ❑GAS � ELECTRIC ❑ <br /> OESCRIBE ���ND SOUARE FOO7�GE IN MV D • T PC�SONA NONE O � <br /> -Tenn�� ►m �rnv�r�e�n� �a �ir�� {�16m' � , <br /> i 6 � b 2oto 2.�z- 51��- <br /> I HEHEBY f,EF71FY 7HA7 I HAVE READ AND E%AMINED THIS <br /> APPLICATIO;J AND KNOW THE SAME TO BE TRUE AND CORRECT AlL <br /> vnoros[ouse oF auaon+a PROVISIGYS OF LAWS AND uRDINANCES GOVERNING THIS TYPE OF <br /> WOFK Y/ILL OE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCA�PTIONOFMtOPEPtt�SHOWNBElO���QiATi r�rwocoriEsl . NOT. TNE GRANTING OF A PERMIT DOES N0T PRESUM[ TO GIVE <br /> �oTS 11 3 eiocK�or � � �5 � 1 b11 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO OF ANY <br /> OTHEH STATE OR LOCAL LAW REGULATING CONST ION OR THE <br /> V Y � - c PERFOiiMANCE OF CONSTRU ION.THAT I AM HORIZED BV THE <br /> (' 7p OWNER Cf THIS PROPER TO PERFORM E WORK FOR WHICH <br /> O�� Dt l0. (l r C f�SOT 0 A'PLICATION IS MA AND I C LY WITH THE STATE <br /> PARCELTA%ID.NVBER CONTRACTORSlAW1�27PCW 6200WAC. <br /> 51 - - I�- - -DI - L - ' � \ � �- S_ `� �, <br /> iRVLT1 LO�N F.NDEN.� 55.TEIEPNONE NUMBER x <br /> SIGUTURE DATE <br /> CITY BUSINE55 ttCENSE NO <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ItEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER GLOSET(TOILET) ' � A/C—MiNDLG UNRS ' <br /> BATHTUB � FORCED AIR SYSTEMS � <br /> tAVATORY(WASN BASIN) � HEAT PUMP ' <br /> SHOWEH ' UNITHEATERS ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DAYERS � <br /> DISHWASHEfI � RANGE HOOD ' <br /> LAUNORY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL � METAL FIREPLACE(1W00D BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR ORAI�I � GAS FIREPIACE ' <br /> BACKFLOW PREVENTERS � GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � � GAS PIPING ' <br /> � EXIIAUST FAN <br /> � i <br /> � <br /> � <br /> � i <br /> � <br /> � � `r <br /> � , �4�_ <br /> � 'i;�<<... <br /> SUB TOTAL E � SUB TOTAL S ; <br /> PERMIT S i PERMIT E � {�_ ` <br /> TOTAL FEE S � TOTAL FEE E ' s,`�`���;' <br /> a` dx•- <br /> FOR OFFICE USE ONLY: "'� <br /> FPONTSETB�CK AE�RSFTO�CK SIDESETBACN PUNGIiGC�NUAIp�p � fEE�� �` �ECEIPiNO �3��� <br /> 7 T � <br /> v FEES VALUATIOH FEE ��!��fT <br /> USE<ONE lOfAREA VACANi511_ ��/�r�:'.'.; <br /> ❑YES ❑ NO pUIIDwC I�� � iOU <br /> NEICNT LIMIT�TION NO OF DWEtUNO 9ZE OF B�OO/f.l � <br /> UNII$ ��./� � PLIIMOIN6 � ��°�' <br /> ��J�. J' —r— F 'f+ <br /> OI:CUPANCY IqIXSIDPoES a�UPANTIO�D B�SEAIENT MECIUNILAI � - <br /> � <br /> GROUP / �h "'j�I ❑YES ,�L`NO � i' <br /> �� �� � ApbItIONALI'L�NCIIf.CM � r <br /> FINESPB�NK4yE��R-/REOD �E�SON�/� � <br /> 1{✓'.� ��/Yl��. OtIIER � . �A���.�. . <br /> FIREAURMREOD RE�SON / � � J <br /> 4y�' ��f.- suie owien+r sunuunce _ , <br /> f. �"� <br /> rmeoFr,ovsr rinNsnrrnov[oov CITYOFEVERETT r�miicwonrcs � <br /> -1�� , f LOCAL SALES ' <br /> —tHV p��E i� n� TAX CODE IS 3105 TOTAL ��`�' " l�� <br /> ��� <br />