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APPLICATION FOR CONSTRUC�TyION P!�RMIT <br /> �CITY OF EVERETT•BUILDING DIVISIC� <br /> 3200 C:EDAR STREET• EVERETT, WA 98201 •259•8810 <br /> C DEMOUTION ❑ COMBINATION ❑ BUILDING p MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJEgTADDRESS:���j� �j�jJ�/p�� �� �l <br /> �07��, lo . �'�?O�' <br /> °fl MqLADO{IESS Citt 21P VMONE <br /> IENANT MAILI�COPE55 CITY ZIP P110NE <br /> A(iCHITEGTOpDE51GNER M�IIADORE55 CIT/ IIP PMONE <br /> '.ENERACONTfl�LTOR MulA0DRE55 CIIY IIP PIIONE SGTEIICCNSE� <br /> �AIECHANICALCONTR�CTOIi MAILADDRESS f.IN 21P p110NE SiAiELICENSE• <br /> � S. C S-70i J/6 '` "s J� � - SJ��F ... .�� 4 $J 5 e2 3�0 Y>a?5� 3GCf' h �,- C.►6.ri�� <br /> W4BMICiCONTPACTOR YqLA0DRE55 :Itt I�p PIIpNE STATEUCENSE• <br /> V <br /> CONTMCT PRICE OF WpI1K C��� <br /> HEATING SYSTEM: C GAS ❑ELECTRIC ❑ <br /> OESCRIBE NNRN�ND SpUARE FOOTAOE WVq.VED LONTACT PERSOK AI�O PNONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnoroseo use oF euuonw — APPLICATION AND KNOW iHE SAR1E TO BE TRUE AND CORRECi qLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> L��L�EUWPTbNOFPH(WERTVI�MRIBEIOWORATT�LHTWOCOPIES) WORK WILL 8E COMPUED WITH WHETHER SPECIFIED HEREIN Ofi <br /> NOT. THE GRANTING OF A PF.RMIT DOES NOT P£iESUME TO GIVE <br /> �oT e�ocK cF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> � PEflFORMANCE OF CONSTRUCTiON. THAT I AM AUTHORIZEU BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOA WHICH <br /> APPLICATION IS MA�E ANO ! COMPLY WITH THE STATE <br /> PMc¢�Tefc iu.eaiuuaep — CONTRACTORS LAW 1827 RCW AND 2?ti.200 WAC. <br /> CONSTNIIGiIONIOANlENOER.�00RE55.TE1EP110NEHUYBEN __���� /. S'� �� �� <br /> ��,.r� <br /> 5 .N�TURE DATE <br /> CITY BUSINE55 LICENSE NO <br /> PLUMBINr MECHANICAL <br /> NO. TYPE OF FU(TVqE Op ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> � WATER CLOSET(TOILEP � A/C—A/HNDLCa UNRS i <br /> � BATHTUB � FORCED AIR SYSTEMS � <br /> IAVATORY(WASH BA91N) HEAT PUMP � <br /> SHOWER � UNITNEATERS � <br /> KITCHEN SINK 6 DISP _ i CLOTHES DRYERS ' <br /> DISHWASHER � RANGEHOOD , <br /> UUNDRY TRAY ' WATER HEATEF � <br /> CLOTHES WASHER � WOODSTOVE , <br /> UqINAL � tiIEfAL FIREPIACE(WOOD BUR�IIJG) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURN�NG) ' <br /> FLOOR DRAIN � GAS FIREPLACE , <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS pIPI�G , <br /> . <br /> EXHAUSTFAN <br /> � <br /> � � <br /> _ ' � <br /> i � <br /> � � <br /> � � <br /> _ SUB TOTAL f ' SUB TOTAI S <br /> PEHMIT S � PERMIT S � <br /> TOTAL FEE E � TO fAL FEE S � <br /> FOq OFFICE USE ONLY: <br /> iRONT SETBiU:H pEAR SETBALN SIDE SCT06CN PUN CI IECN NUMAFR !'EF RECEIPT NO <br /> OSEIONE IOT�REA VAC�NiSITE �EES VALUATION FEE <br /> ❑YES ❑ NO �- <br /> - OUIlf71NG � <br /> MEIOHT LIMITATION NO OF OWELLINC SRE Oi BIOCrtI ' <br /> UNIiS � <br /> PIIIlA01NG � <br /> OCCUPANCY NJ p SIM�FS OCCUPANf LO�O 9�SEMCNT � <br /> GNWP MECIIFNIC6l <br /> ❑YES [� NO ---- <br /> FIPESPPINKLERHEO'D I1E�SON �CUIIIONq PI�NCIIFCN i <br /> i <br /> OIIIE(i � <br /> � FIBEAUpMREO'D REASON <br /> _ � <br /> ' STRIE OIIIIAIIlG SIIfiC11Rp6E <br /> TYPE OF f.ONST FIANSMPpOVF.D[IY �� <br /> CITY OF EVERETT runnr,wonKs <br /> LOCAL SALES — —------ .--1__ <br /> oeTe TAX CODE IS J105 TOin� � <br /> I <br />