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� ,�. <br /> /�PPLICATIt�N FOR CONSTRUC110N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVEREIT,WA 98201 •(425)257-B810 <br /> ❑ OEMOLITION ❑ COMBINATtON ❑ BUILDING �MECHANICAL PLUMBING ❑ SIGN <br /> L � <br /> PROJ CT A D ESS: � <br /> � � <br /> M�4AODR 5 CITY IiP PNONE <br /> IENANT/� e u��1�ODAE55 G7Y ZiP PNONE • <br /> �qGHIiCCi OR DESIGNER MML�D�RESS <br /> pry IIP �NONE <br /> GENERM GONiOAGTOR N�II�DDRE55 <br /> C17Y llP PHO4E SInfE IKFNSE� <br /> MECN`NICALCONTRRCTOR M��LAfYJAE55 ^ <br /> LIfY 21f PIIONf ST�Tf LICENSE� <br /> � �` ) J cs�. Zs � .�'�cz EL«r` z 2 4> <br /> ��n, j�p FHO^1F. STAIE UGENSE� <br /> PlV BINGC041R�f,TpR MMU E55 <br /> CONLMCTPRICEOF WORN r��0� HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WOHN�HD SOW RE FOOTAGE INVOIVED CONT�Ci FfR50N�ND PNONF. <br /> � � '� � C"re��rv- Z 9U oS`l�S <br /> 3�� <br /> I HEREBY CERTIFY THAT 1 HAVE READ ANO E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF OUILD�N6 PROVISIONS OF LAWS AND ORD�NANCES GOVERNING iHIS TYPE OF <br /> WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEPEIN OR <br /> IEGALDESCRIPTIpNOFPROPERTY(SNO'NNBELOWq7�TT�CNTWOCOPoF.S) NOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE <br /> Lot oi�N p� AUTHORITY TO VIOLATE OR CANCEL THE PROVISfON OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTION OR THE <br /> PERFORMANCE OF GOIJSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS l B27 RCW AND 296200 WAC. <br /> PMCEL T�X 1 D.NUMBER � n <br /> SL . /"—J`'—i'7 <br /> CONSiRUCT10N LO�N LENOER.AIX`�E55.TELEPHDHE NUMBER x D�iE <br /> SIGN <br /> QTY BUSINESS UCENSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEMI FEE NO. TYPE OF EGUIPMENT <br /> FEE <br /> WATEH CLOSET(TOILE� � A/C—NHNDIG UNITS � — <br /> BATHTUB ; FOPCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNIT HEATERS � <br /> KITGHEN SINK 6 DISP � � CLOTHES DRYERS ' <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY ' WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � — <br /> i METAL FIREPLACE�NOOD BURNING) <br /> URINAL ' <br /> DRINKING FOUNTA�N ' <br /> FIREPLACE INSERT(WOOD BURNING) � <br /> � GAS FIREPIACE � <br /> FLOOR DRAIN � <br /> � GAS RANGE ' <br /> OACKFLOW PREVENTERS � <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPING ' <br /> � EXHAUSTFAN <br /> i <br /> � � <br /> i � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL E i SUB TOTl1L S i <br /> i <br /> PERMIT S � <br /> PERMIT TOTALFEE $ ' <br /> TOTALFEE S <br /> FOR OFFICE USE ONLY: nECFmrNo <br /> PRONT SFTPRGN PFRRSF.iBALK SIDESEiBAf.N <br /> PtANCnECRNUTA [P �E� <br /> fEES VALUATION FEE _ <br /> 115E 20YF l0i MEA V�CANi SI1E i <br /> OYES ❑ NO BUIIbWf, <br /> i <br /> NEIGNTIIMIT�iION NOOFUWELLINQ 5�2EOFBlOG�f� : <br /> UNII$ PIU�AAiNG ___�t— <br /> _ <br /> pl;C1IDANCY HO 0�510niF5 OGCUP/AI!l0\0 OASEMENI MFCn�NIGI _ __ <br /> f.pOUv ❑vE5 ❑H� , <br /> nDDIl10NA1.Pl�N CMLLM � <br /> � <br /> FIRESARINNIERREO'0 �F�S(N1 � � <br /> OiNER � — <br /> FIP.E FIAFM REO'� REA��� � <br /> STAIC BIIM1UIN6 SUI1Cf1At16E � <br /> tYPEOPCONST PL�NS�PPPO�ED9Y CITYOFEVERETT ���A����AKS . ---- <br /> LOCALSALES - ` <br /> o�iE TAX CODE IS 3105 TOTAL __ — <br />