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APPLICATIL��1 FOR CONSTRUCI dN PERMIT <br /> CITY OF EVERE I T•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,Wp 98201 •259-8810 <br /> ❑ DEMOIITION ❑ COMBINATION �Q BUIIDING ❑ MECHANICAL ❑ PLUMBING C SIGN <br /> PROJECT ADDRESS:�/r-j�j�� �A.�}y <br /> NyL17NE L�11/� �O�'�5'�1/L��TS�r,�v NdK/ ta_.�IT G1�lR G1P�2�4 �J� ., <br /> MNL�obArss-' Z�� PNONE <br /> �G/F�' /�N/N6)t <br /> iEN�qT - III�iI�ODRE55 dTY IIP PIIONE <br /> ARLM1ECTqIDESMNEP MIqLAD0�E55 � �/���`7�•`�-"—/-rLG � � �/ /� <br /> ������j�T�/.1/_77/7�I —�� 71P PHONE <br /> , //1� /7/g ���'�frl P/ g� e7i�"�7'Wi't �?� �338�,�-- <br /> utncNµGIX�T ��� ipq MNL 11DDRE55 LITV 1�—�pONE SUTE LICENSE/ <br /> N/h- <br /> MECNANIG0.CONTR�CTOR MIULADDRE55 CITY ZIP P11pNE STATEUCENSE� <br /> M�� <br /> PLU4B �:,N:inw�,iuA M�ILADDRE55 CITY ZIP P110NE STATEIICENSE� <br /> 7L�PE L7�f�)s!N/N� <br /> CONTq�T PRICE pF Wp11K <br /> HEATING SYSTEM: O GAS ❑ ELECTRIC ❑_ <br /> DESC�MlE W0111f AMD SOl1�RE FOOTA6E INVOIVED CONTACT VERSON MI�PHONE NO. <br /> �1`�tE�, 7G'�� yllv'n f'/ci'C-uP 7/Slil�i�c � <br /> 'Y�)rv✓'�'3 397e33 <br /> I HEREBY CERTIFY THaT I HAVE READ AND ExAMINED THIS <br /> apoposeo vse os su�aHo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEWLpESCpptlq/aP�qp�q}y��g��p�ypq�n�N��ES� WORK WILL BE COMPLIED WITH WHETHER SPEqFIED HEREIN OR <br /> NOT. THE OHANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or µ� or __ AUTHOHITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE�ULATIN(i CONSTRUCTION OR TNE <br /> -�����"I{Z' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ow�cnTNc i.o.Mna�p CONTRACTORS LAW 18.27 RCW nND 296200 WAC. <br /> ��-2-014-�X.1'>4- �uA ' <br /> CONSD111CTId1 LOI1N�ENOER.�DD11ES5.TELEPHONE NUMBER �.J dLQT���� /�' I�%(�" <br /> r�� « ici <br /> S'I(�iN�TURE D�TE <br /> " CITY BU$INESS LICENSE Np. <br /> ����� MECHANICAL <br /> ND• TYPE OF FlXTUqE OR ITEM FEE NO. TVPE OF EWIIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—AMNDL�UNrt'S � <br /> BATHTUB ; FORCED AIR SVSTEMS � <br /> LAVATOqY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 6 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � RANGE HOOD , <br /> � LAUNORY TfiAV ; WATER HEATER � <br /> IX.OTHES WASHER � WOOD STOVE , <br /> URINAL � MEfAL FIREPLACE(WOOD BIiRNING) � <br /> DRINKINCi FOUNTAIN ; PIREPLACE INSEFiT(WOOD BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING , <br /> ' IXHAUST FAN � — <br /> � ; <br /> i � <br /> � , <br /> � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S ' � Y PERMIT S -i— <br /> TOTAL FEE S � TO7AL FEE S � <br /> FOR OFFICE USE dNLY: a/3, � <br /> FRp175ETBACK REMSETBACN SIOESETBACN PLANGIIE,[.``NU� FEF�^ /� pECEIPTNO <br /> � d � ✓3 �/ <br /> usEZONE_ IOT�HE� V�CANTSIiE FEES VALUATION FEE <br /> l' <br /> _Sl ❑YES � BWIDINC ' <br /> MEIOHTl1MITATION NOOLOWELLIN6 SIZEOFBLOCRI �� �� � i �v <br /> 5�/� � IIN115 i <br /> �, rl �v , �„MB�� ; <br /> OCCUPANCY NO Of SIMfS OCCUVANT IO�D BASEMENT � <br /> 6R MECHANICAL � <br /> Z f� ❑YES ,�(NO � <br /> � <br /> FIflESPRINKLERREO'D REASON AOU1110NQPUNCHF.CN � � . <br /> y� . ��Tl�u� �:,,Ea ; — <br /> FIFEMMMREO'D PE�SON <br /> � <br /> �f �L�� � $TREBUq01NO511RC11.1110E i �n <br /> TYPEOFCONSi PLAIJSAPPfIpyEDBY CRYOFEVEHE7T �IIBIIf,WOPKS � <br /> � �M LOCAI SALES --%— <br /> o�rE IO TAX CODE IS 9105 7oTAL t�(�� ;j <br />