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APPLICATI�..� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEOAR STREET•EVERETT,WA 982p1 •259-8810 <br /> ❑ OEMOLITION p COMBIHATION ❑ BUILDING ❑ 61ECMANICAL �p�U�IBING ❑ SIGN <br /> PpO,IECT AODRESS: L���Z �O`/�Z y <br /> / Mut.00ness pn. <br /> /�_""�r� /1/i'7'�� 21P P110ME <br /> TENN/T YN11100PE55 <br /> GTV ZIP PNONE <br /> ^—Y-1 T�(�L�s,'Z.Vd� �f,j�p(J PE55 CITY IIP PHONf <br /> �`T <br /> GENERMGONiR�qOq M�IL110Df1E55 dfY <br /> SIP PIIONE 51qE IICCNSE� <br /> MECH�IIINJIC�KC'//T.R��CTpR MAtLADDRE55 ��(� �CIIV/� <br /> G' " , �`w��� � /J� ru�cfdy r+j/ �Z G�.1` IIP PIIONE STRT[LIC[NSE� <br /> viwaeM� ncer mi-�+o'P 93'2`jo 4�,3�8Z7 GHftyPP.L �ls'7�.�— <br /> ��rv Z�P PNONE ST�TE UCENSE� <br /> CONTR�GT PR10E OF WIX1K f.O <br /> ��" � HEATING SVSTEM: ❑GAS ❑ELECTRIC ❑ <br /> ce�wam u+o sou�ac cooT�r�vaveo <br /> CONTACT PERSON M!0 PHpNE Iq <br /> � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �o�os�o�sE oF ampHo APPLlCATION AND KNOW TNE SAME TO BE TRUE ANO CAqRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �����PT��P��RTYI�pMNBEIOWORATiACHTNqCpp�ES) �'�'ORK WILL BE COMPLIED WiTH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DpES NOT pRESUME TO GIVE <br /> � ��T ��K � AUiHORITY TO VIOLATE OR CANCBL THE PROVISION OF ANi <br /> � 07HER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFOP.MANCE OF CONSTRUCTION.TMA71 AM AUTMOHIZED BV THE <br /> OWNEN OF THIS PROPEqTV TO PERFORM THE WOqK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> v�nce�ruc i.o.ruue�n CONTRACTORS LAW 18.27 RCW AND 2g6200 WqC. <br /> wMsmuen�iaw ie�n.woaess.reiErrar+e m�,+een <br /> X <br /> SION�TURE D�TE <br /> CITY BUSINESS IICENSC NO <br /> �u�� MECHANICAL ' k'- <br /> ►b. TYPE OF FlIfTURE OR ITEM FEE NO. 7ypE pF EpUIpMENT <br /> WATER CLOSEi(TOILEn FEE <br /> BATHTUB � NC—A/HNDLG UNITS , <br /> � FORCED AIF SYSTEMS i <br /> UVATOqY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � <br /> KITCHEN SINK d UISP � UNIT HEATERS , <br /> i CLOTHESDRYERS <br /> DISHWASHER � qANGE HOOD � <br /> LAUNDRYTRAY i ' <br /> CIOTHES WASHER ; �'�'ATER HEATER � <br /> URINAL WOOD STOVE � <br /> ' MEfAL FIREPLACE(VJOOD BURNING) � <br /> DRINKINGFOUNTAIN ; FIREPLACEINSERT(WOpDBURNING) <br /> FIOOR DqAIN � GAS FIREPIACE � <br /> BACKROW PREVENTERS ' <br /> i GASRANGE � <br /> / SINK(SERVICE—BAR,ETC.) � GAS pIpING <br /> n9 C I''Dryl/ IXHAUST FAN , <br /> � <br /> i <br /> � —� <br /> i � <br /> SUB TOTAL S ; SUB TOTAL S � <br /> PERMIT f • - � PERMIT S , <br /> TOTALFEE f 3 � TOTALfEE E � <br /> FOR OFFICE USE ONLY: <br /> lRONT$Etti�LK PE�P SFiB�CK SIDE SETB�LN I'UNCIIECN NUAI9CB f[f RECBP�NO <br /> u5E ia+e toT ane� v�ceNr Srte FEES VALUATION FEE <br /> OYES ❑NO <br /> �NlD1NG � <br /> NEIGNTUMIT�TION NOOFOWEWNG $IZEOFBIOG/f.l i <br /> UNIfS <br /> PLUNOING <br /> G���'1CY NO l�5�(wbES OCCUPANf 1011D B�SEt1ENi I <br /> MECNeNIL�L � <br /> ❑YES ❑NO � <br /> FIRESPfUNKLEqREO'O RF�SQ4 �DDIf10NALPlANCNf.CN � <br /> � <br /> _'�i-- <br /> FIREAIARMHEO'U NE�gpN O1H[q <br /> ST�IE BWIDIN(i 511RCN�qCE i <br /> TYPE OFf,ON57 PLANSAPPROVEOBY CITY OF EVERETT PI�BIIf,WORKS ' <br /> LOCAL SALES _ __� <br /> o.TE TAX CODE IS 3105 TOiAL •• <br />