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APPLICATI� A1 FOR CONSTRUCti .ON PERMIT <br /> CITV OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,Wq ggpp� .259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDINfi ❑ MECHANICAL ❑ PLU111BING <br /> PROJECT ADDRESS: ❑ SIGN <br /> - �o r-z r��� ,3y �t�� � rvF�T�, w�-���Zd�J <br /> o-v/mea u•i�oor+Ess an <br /> GvILL(•���! P a�j�T I�P PNONE <br /> �mG� Mu���,-,d y/ S�v�Tb Ic� i r.✓/} y�� y�r Czdb t-G� <br /> �v� T• / �� PHONE <br /> 9��0� <br /> •NL�MILGT OR pE51GHER M�II�OqtE55 LITY <br /> IIP PNpNE <br /> �u ' wer�r/tsse- �9 z/� 36� At� v✓ G'1NNr�fl. c.,ift 9 / <br /> G� 4ML�OpiE55 J ��+ /2/JL ) L� Q I <br /> C�TY—� 7 P P��ONE+""r5 / !' <br /> T �S6 D�tie/NrNBp si•reuceruse. I <br /> 4ECNNIIGLLCONTR�GTpi Mi11l�DDRE55 f.1iY <br /> �I/�} 1�� ���E ST�iE LICENSE� <br /> PlU4lINGCONTR�CTON WIL�WRE55 CIIY <br /> �//f} j�P P�E STATE UCENSE• <br /> CONTMGi FMCE OF NVf1K <br /> S� NEATING SVSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> �SC�lENVqK�MDSdUREF TI1pEMVOlVEO <br /> LONTACT PEP$pry�NO p�lp��p <br /> �_ �/J/A� /���' � <br /> 6�-f '�—� <br /> Ti,vo �zu Botin.,,,i � y <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> w+oPosEn se or euad APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �}��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> 1E6iLL���Pn�"aP�pn'�s��e�iowan�rt�cxiwocories� �RK ��� BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR <br /> NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �oT "Z"14 atocx_J.�_� � AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> � p ON O H1� PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> _ �Oi NTN vV/�!�/rNG ON APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> �����'�' p - CONTRACTORS LAW 18.27 RCW AND 296.200 WA�. <br /> i r - <br /> Cp15 ULTIp�LON1�ENDER.�Op1E 5.TEIEPNONE MAI�q <br /> x <br /> SN3N�TUHE D�TE <br /> C�TY&19ME55 LICENS[HO <br /> PWYMN6 MECNANICAL <br /> �. TYPE OF FlI(TURE OR ITEM FEE NO. Ty1�E pF EOUIPMENT <br /> WATER CLOSET(TOILET) �E <br /> BATHTUB � �—�NDLG UNITS , <br /> � FORCEDAIHSYSTEMS � <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> KITCHEN SINK 8 DISP � UNIT HEATERS , <br /> � CLOTHESDRYERS <br /> DISHWASHER � RANGENOOD � <br /> UUNDRY TRAY � WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BL'FlIJING) ' <br /> DRINNING FOUNTAIN i FIREPLACE INSERT�WUpp gURNING) ' <br /> FLOOR DFAIN � GAS FIqEPIACE � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> _ SINK(SENVICE—BAR.ETC.) � GAS pIpING � <br /> � <br /> EXHAUSTFAN <br /> i <br /> i <br /> � � <br /> SUB TOTAI. f � SUB TOTAL S � <br /> PERMIT S r PERMIT S � <br /> TOTALFEE f � TOTALFEE E � <br /> FOR OFFICE USE ONLY: <br /> F�T��'�K AE�R$QTBACK SIpESFTBl1CN P��NCIIECRNUMpER IEF /� RECEIPTNO <br /> Q �� <br /> USETONE ior�AF� V�CANi51TE FEES VALUATION <br /> ❑res ❑ r�o FEE <br /> BWIDINb � <br /> HEIuNT UMIT�TION NO Oi pY/E�UNG � �- <br /> UNRS S�ZE Of BIOGR.I <br /> 5 O 7 MVMBING � <br /> � PpANCY Iq(1f 5�(Mb6 OCWP�NI�O�D gASEMENT — � <br /> p. p� '7 � MECH�NIC�L i <br /> P ��� �� ❑YES NO <br /> IRESPN�NKLERREO'D REASpry �DdT10N�11'tANCNF.CN � <br /> No � <br /> ---T-- <br /> 01NEF <br /> FIiIEMAqMREO'D Rf�Sp1 <br /> NG STqE BUIIDIN(3 SIIRCHAqGE ��� <br /> TYPE Oi CpNSi F��N$/,nPpOVEO BY -- � <br /> / f CITY OF EVEP.ETT ruenr,woaxs <br /> � �%� LOCAL SALES _,__ <br /> o�tE 7� (, T/.% CODE IS J105 TOTAL <br /> - ! 7 �'�.7 i) ., <br />