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APPLICATION FOi� CONSTRUCT�ON PERMIT , <br /> CITY OF EVERETT• BUILDING DIVISION �C^r��� <br /> 3200 CEDAR SIAEET� EVERETT,WA 98201 • (425)257-8810 �l�T <br /> ❑ DEMOLITION ❑ COMBiNAT10N ❑ BUILDING ❑ MECNANICAL f7� PLUMBING O SIGN <br /> PROJECT ADORESS: 3 72 C, COC.I�5' � �/�N�-('� ��G�12L'77' <br /> B�L�2f lG FNNICNHUSe12 372y ce�c(lY L.�/L'7L?� t�FN 2S��6Z�E, <br /> OWNFR M�4�WNE55 C�i1' bP VNDNE <br /> TEN�NT MMLADDR[55 LIiY 71A PNONE . <br /> GIqpY �W@Kintst�r�1 <br /> �RGWnGiORDESIGN[fi MMI�DDRE55 GITY )iF PNCNf <br /> C12cN�ns Oevec�P�e�--��r ��sc 52� 91s� RV�_LtVC�ttL7T 335-Y5�o C��107'c7�7�F <br /> GFN[ReILONiqAG1IXi Mu�A00�E55 C17Y 7i� PN9V[ SfRfCtICFNSF.� <br /> MFC111NI��LCONTRN�TOR M�I��[�.RESS qTY ?.IP P110N[ STAfFUC[NSE� <br /> �oQrNweSr Pcut�B�r�c> <br /> PIUMBINGCON1R�f,TON M�4ADDRE55 CIiY IIP PNONE SUTFIICENSEr <br /> CONfMCi PRtC[OF WpRK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK�Np SOU�PE FOpT�GE IHVOWEO LONT�Ci PEN>ONANp PHONE NO <br /> I HEREBI' CERTIFY TNAT 1 HAVE READ AND EXAMINEO THIS <br /> PAOPOSEDUSE OF BUILDINC APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 AL:. <br /> PFOVISIOIJS OF LAWS AND ORDINANCES GOVERNING THIS TVPE 6F <br /> WORK WII.1. BE COMPLIED WITH WHETHER SPECIFIED HEREIN O:i <br /> IEG�LDESCRIPTIpNOFPfiOPEPTY�SNOWNBELOWORATTACN1WDCpME51 NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br /> iot_ eiocK ov AUTHORITY TO bIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTtON OR THE <br /> PERFORM4NCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM iHE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> PAqCEU�N I D.NVMAER CONTRACTORS LAW .��D 270.200 WAC. <br /> LONSTqIILTION LO�N LEN�ER.�ORE55.TEIEPHONE NVYBFR x �,/� //Zg//` <br /> SIGNRURE D��C <br /> Cltt BUSINE55 L�CENSC NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> Z WATER CLOSET(TOILET) � q/C—AMNDLG UNITS � <br /> BATHTUB � FORCED AIR SYSTEMS ; <br /> G LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT}IEATEFS ' <br /> KITCHEN SINK 8 DISP � CIOTHES DRVERS i <br /> _ DISHWASliER � RANGE 400D __ �— <br /> LAVNDRY TRAY � WATER HEATEq � <br /> CIOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN FIREPLACE INSEFT(WOOD BURNING) <br /> FLOOR DRAIN � GAS FlFEPLACE � <br /> BACKFLOW PREVENTERS ; GNS RANGE ; <br /> SINK (SEFVICE—BAR,ETC.) � GAS PIPING <br /> � EXHAUST FAN <br /> � <br /> � <br /> � � <br /> � � <br /> � <br /> � � <br /> SUDTOTAL 5 � SUBTOTAL E <br /> PERMIT $ i PERMIT $ � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> fRDNTSFTfl�LK RGAp5f.T8�CN S�DESEIB�CK PL�NCII[CNNUMHfR fE! RFf.F��iNO <br /> uSEeovE 101�RE� WCANfSIiE FEES VALUATION FEE <br /> ❑YES 'J NO —�— <br /> __ AUII UMG � <br /> �^'.�GN��iMIi�11U4 NO OF UWEUING SILE Of glOG�fl � <br /> lMrtS pl UTABINp � <br /> - ---- � <br /> CCCUPANf.Y NO O�S��ARS IX:CUPANIIUAD B�SEMENI � <br /> GROUP MFf.NRNIUi � <br /> ❑YES ❑NO — — � — <br /> FIRESPRMkLEPNEO'� BFASON AODiIIpNAI.f7ANGIf.CK <br /> —i-- <br /> O111ER � <br /> _ i <br /> FlREAIAPMREO'D RFRSOv <br /> StAIC BUIl0iN6 SURLNAl16E <br /> i <br /> ttveorr.o�+sr r�nvsnrraovEner CITYOFEVERETT runnr.wnn.s <br /> LOCAL SALES — — ---- — - <br /> o�TE TAX CODE IS 3105 TOTA: <br />