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APPLICAT�N FOR CONSTRUC*ON PE�MIT <br /> IJ , 1 y�� CITY OF EVERETT•BUILDING DIVISION TUAJ y � <br /> ��'�'�� j 1 i 3200 CEDAR.,TREET•EVERETT,WA 98201 •257-8870 � <br /> ❑ DEMOLITIO� � ❑ COMBINATION ,q BUILDING Cl MECHANICAL ❑ PL MBING ❑ SIGN <br /> PROJECTADDRESS <br /> - - �E - �l <br /> OWNEP MAIL�DDflE55 CIiY 1� PNONE <br /> ThnY=�r Fr rr;\�ll f I�FtiM �o"� 1"�G NW f(1f�RvSvli�� �nIA`1�' -11 (4 S� �A h�l <br /> TENANT M�RAOOPE:S GtT ZW PN@�E <br /> \\nT1�tmFsrn7=Sr JI �R( R<F�v�HN F�iF A qp7n� �4 �l '7�r� /�2�� <br /> MLNIiECTOf10ESIGNEP M�ILAOORE55 LIiY ZIV PIIONE <br /> GEIIEMLL@ITNACTOR MARMDFE55 CI1Y ZW PIIONE STAiELIC[16E� <br /> MECNANKALLOMPACTOR NAiLA0IX1E55 LRY ZW MIONG SI�i[IICENSE� <br /> R440RlGCA1RPALiOP M4LfU041E55 LITY 2w PIIONE S1�lELICE115E� <br /> CONLMLTPPICEOF WOPI( <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC Q� NI� <br /> DESCfliOE W011K NN W WPE Fb]UGE VNQVEO fANiAG!PEPSON/JN PIIONE Iq. <br /> '�V��J� . �1� � l l. <br /> 1 HEREDY CERTIFY THAT 1 HAVE READ AND E%AMIIJED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT.ALL <br /> raoroseouse orom�oixo PqOVI510NS OF LPWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HLREIN Ofl <br /> LEGALCESLPiPLIONOFPPOPEfltt�SIqW11B[LOWOPATiACHT4LtOPiES� NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioi �5 oiocn�or 'V— � ' l AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEfl OF THIS PROPERT'!TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAUE AND I COMPLY WITH THE STATE <br /> v�nCEL*rx i D.e�UuoEP CONTRACTORS LAW 1827 RCW ANO 296.200 WNC. <br /> ca�+sreucnox�o.w�er+ocn.anoness.rc�cwwx¢rmuoen x �C' y/ � f0-�^y-nA <br /> srorv�nne onre <br /> arr ousu+ess i¢nsc iro. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%7UPE Ofl ITEM PEE NO. TYFc OF E�UIPMENT FEE <br /> WATER CLOSET ROILET) A/C—A/HNDLG UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORV�WASHBASW) � HEATPUMP � <br /> SHOWER � UNITHEATERS <br /> KITCHEN SINK 8 OISP i <br /> i CIOTHESDRYERS � <br /> �ISHWASHER RANGEI100D <br /> LAUNDRY TRAY WATER IIEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL � METALFIREPLACE�WOO�BURNING) � <br /> DRINKING FOUNTAIN I FIREPLACE INSERT(WOOD�URNING) <br /> FLOOR ORAIN GAS FIFEPLACE <br /> BACKFLOW PREVENTERS � GAS RANGE <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> � E%HAUSTFAN � <br /> ; __ <br /> SUBTOTAL S j SUBTOTAL S i <br /> PERMIf 5 PERMIT S i <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> iR�NiSEID�CN qE/.PSEiBAIX SIO[SELB� PUNCHEC YOC� fEE �5� pELEIPi1q. <br /> 2b ' _ 5 <br /> USE +E ioTeaEe VncurtSiiE �� FEES p VALUATION FEE <br /> ❑vcs euiioiHc :n .S � � �'" �� <br /> ���ic3iurt • �w.oFowe� � S�2EOfB�DGrt1. � , , — <br /> uxrts js vwuonm � C <br /> WCUOANCY I:OCiStOPES OCCU RLO�O O�SEMENi MECNANIC0. <br /> GPOUP / <br /> � / ❑VES NO <br /> flFESFPInNLERFEO➢ PEASON �DOIiION�LVUNLHELN <br /> /;'c�i C 0�='-� <br /> oTMcn <br /> PPEAUNMflEG➢ REAiON \ <br /> �� ` Q�'\ SiniE6UROINO5URL11AlIGE D <br /> ) <br /> tVPEOFLONSi PWIS�PPqpvEOBY CITYOFEVERETT PIIBLICWOfINS � <br /> ��-.�' , � LOCAL SALES <br /> (/ `!.� oere /�� //>A TAX CO�E IS 3105 To7Al <'CI � <br />