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APPLICATIG_J FOR CONSTRUCT. �N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING O SIGN <br /> PROJECTADDRESS: �� ( � ���',L (:i`; <br /> OMNER MML1100AE55 pTY ZIP P11pNE <br /> �+ <br /> "�� (l r�/.��7 i�oi yi `,� ��03 9�a�� .�G�`i- �i •��Yz <br /> 7E1UN7 MMlA0IX1E55 GTY IIP PNONE <br /> 2S - �✓�a�- <br /> �RGMTEGT Ofi 0E51GNFR MML 11DpiE55 GITY 1�� PHpNE <br /> GENER/il GONiR�LTOR MNl�00RE55 pTY jlP PIIONE SUTE LICENSE� <br /> �C��;1,-J f)!/Cx:t; <br /> MECM�MiCAL CONTR�CtOR A4111�Oq1E55 qTY zlP PIIONE SUTE LILENSE� <br /> �1�� /��- ��U ��C'i���/��� �i�10fiG'i✓//..r=1 `%�tSl`f� '�� i�S-7D1'% �LE1717 �-: j`'a. <br /> PLUABMGCONTRIICTOR M�ILAOORE55 CIfY ZIP PNpNE STATELICENSE• <br /> . CONiRA�T VIFCE OF WIX1K <br /> C,+GUU HEATING SVSTEM: GAS ❑EIECTRIC ❑ <br /> oescwee wa�m u+o sou�ne FooT�mvaveo � conT rcnsoNµo rxpr�rw <br /> � j:���irSCL G �rS i-(r,('.y,7Cc` � -� L. ��ar- �S � ��'���i � r�. ;(G-`,6f%�7Ci�? <br /> �' S �i�li�✓`' ���;✓Z �i!!'N"y1-�G <br /> � I HEREBY CERTIFY THl1T I HAVE READ AND EXAMINED THIS <br /> Pnovos¢o usE oF e�n�dra APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �/"_�/�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> < < WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> lEGK0E5CMPilONOFNIOPERTY�5/qWNEELOWOR�rt/iCM7W0001'IE51 NOT. THE 6RANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> � wt e�ocic a AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE Ofi LOCAL lAW REGULATINO CONSTRUCTION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK WR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> PMICELTl1%I.D.NIMlER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> r ` <br /> { il / <br /> CONSTRIICTipI LONI�ENO[R.I100RE55.TEtEPIN)NE NIMBER x 1 , � ..�� � <br /> �0 ,��/_� /+�ll _ ,.C��-�� � " d�IY' <br /> SION�iVRE Dl1TE <br /> C�TY BUSINESS LICENSE NO. <br /> PLUYlINO MECHANICAL <br /> NO. TYPE OF flXTURE Ofl tTEM FEE NO. TYPE OF EQUtPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDLG UNfTS � <br /> BATHTUB ; FORCEDAIRSYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS ; <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAV ; WATER HEATER ; <br /> CIOTHES WASHEH � WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> EXHAUSTFAN ' <br /> � <br /> i � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL S � SUB TOTAL S ?J � .. <br /> PERM�T S � PERMIT S / � - <br /> TOTAIFEE S ' TOTALFEE S '— <br /> FOR OFFICE USE ONLV: �� . ���` <br /> FBONT SEiPACK NE�R SE7BACK SIpE SETB�CR M�N CHECe NUMBGf1 fEF Rff.EIPT NO <br /> SD �,3 <br /> u5E Zoqe toi�nen v�pHr srte FEES VALUIITION FEE <br /> •— <br /> ❑YES ❑NO BWIDIHf ! <br /> � <br /> � <br /> NEIGNTUMITATIp/ NOOFOWEWNG SIZEOFBLOGR.I <br /> VNIfS PqJId01NG � <br /> T <br /> OCCUP�NCY /q Of SIOHi[S OCCUP�NI LO�D BASEMENT � <br /> G�P MECM�NIGM <br /> ❑YES ❑NO � <br /> FlRESPRINNI.EqREO'D REASO`! ADD1110N�LPlANC�R.GK � <br /> O7NER � <br /> FIREMARMNEO'0 REASON <br /> S1�lE BU�IDMQ SUtICN�ROE i <br /> Tvveovr,ovsr vinNsenraovener CITYOFEVEREIT rupiir.wonks ' <br /> � "��-S� LOCAI SALES --'— <br /> DATE TAX CODE IS 3105 TOTAL � " <br />