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.� ^ <br /> APPLICATII..� FOR CONSTRUC1 .dN PERMIT . <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: <br /> OVINER M/JLADIX1E55 CITV ZIP PHON[ <br /> �r, V �.�,k ���s'F.r�rs9"I/�cw l'✓�r,-� Tl� 9,r—a-v3 35S��3;z , ;t , <br /> TENNJT MNt�00i1E55 CITY � 11p p110NE �(.�.j � _ <br /> . , r_,'.,�_. <br /> `` . <br /> ARCMTCCTOqDE51GNER MAII�DOPE55 pITY zIP PHONE ' <br /> ` ..r� <br /> GENERqCONTR�CTOP MAIL�DORE55 CI7V IIP PIIONE SUTEIICENSE� <br /> .�e�<•pr ���h.�J/li-:9 �� .SL �iRr.�'�/f 9�F'Y�/�" 33 '/ G//3 LEHSA�G^y'('oL� �J <br /> MECNANICI�LCONTR�CTOR MMLADDRE55 dtt ZI� PIIONE STATELICENSE� T— � . �- �� <br /> :"A�. <br /> MUMBWCrCpNiRACTOR M�ILADDRE55 CIfY IIP 1'HONE $TAIEUGENSE • . ' <br /> :���L <br /> CONTMCTiRIC�WORK �' ��� <br /> ,y� HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ -�' , _ <br /> UESCPoBEW'JRKANDSOU�REFOOT�GEINVOWED CONi�CT SONANO E , . , �,r-�� � <br /> �i s . �3 y-G/ � • . <br /> � s ac <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoroseouse e+mp APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> {S�c�.t/C�( WORK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br /> �����PT����Rn'I�p��LOWOR�TTKNIWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT �IOS eiocK_Q D/� � i AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH - - - <br /> APPUCATION IS MADE AND I COMPIY WITH THE SUTE � `�� <br /> cw��vucJ.o.riur�een CONTRACTORS lAW 1B 7 R W D 296200 WAC. '�� <br /> �U37 -�vi)- ids�Oa n � �:f.� <br /> COM57RUGIlON lOM!LENDER.�DORE55.TELEP110NE MIMBER x � . . . .!'. <br /> SIGN�TURE D�TE � � . � ',y� <br /> 1'6A' <br /> GTY BUSINESS IICENS[NO. � �,��� '�,�' <br /> �V�� MECHANICAL '�'^u� <br /> ►10• TYPE OF Fl7fTURE OR I7EY FEE NO. TVPE OF EOUIPMENT FEE ��"r•ir� <br /> WATEq CLOSET(TOILET) � A/C—A/HNDLG UNITS � � - � �`'� <br /> BATHTUB ; FORCEDAIRSYSTEMS � � - <br /> � <br /> LAVATORV(WASH BASIN) � HEAT PUMP � . � - -- <br /> SHOWER � UNIT HEATERS � � - <br /> KITCHEN SINK R DISP ; CLOTHES DRYERS ; � � .� �� ' <br /> DISHWASHER � RANGE HOOD � � - � <br /> UUNORY TRAY ; WATER HEATER � � - � ,- <br /> CLOTHESWASHER � WOODSTOVE —� . � ' �. � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � � � . � � <br /> DRINKING FOUNTAW � FIREPLACE INSERT(WOOD BURNING) ; � � �'��� � <br /> FLOOR DRAIN � GAS FIREPLACE � -� <br /> BACKFLOW PREVENTERS ; GAS RANGE ' . � ��, � <br /> ..7 <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � � � - - <br /> ' IXHAUST FAN � ��,;`�r��'y � <br /> � <br /> � � ,I_k <br /> i � � <br /> � � <br /> - ` ' . - ".Y� e <br /> i � F.� <br /> SUB TOTAL S ; SUB TOTAL E ' � <br /> � <br /> PERMIT S � PERMIT E i <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE U5E ONLY: <br /> FROHTSE7BACI( REAR$E7BACR SIDESEiB�CN PtANC11ECNNUMBFR fEf- REf.EIPTNO <br /> � <br /> USEZONE IOi�REA yACANT511E FEES VA�UATION FEE <br /> ❑VE$ ❑ NO pWIOWG f I <br /> HEICNTIIMIT�TION NOOFOWELUNG 512EOF9lOG�fl � <br /> UN115 <br /> PlpM01NG � <br /> i <br /> GC�CO�PANCY NOOfSi(MOFS OGCUPANTLO�D B�SEMENT MELM�NILRL I " � � � . �� <br /> � <br /> ❑YES ❑ NO <br /> i <br /> FlflESPRINKLEflREO'D RFASON <br /> AppIIIONRI PUN CNfCR � <br /> on�en ' <br /> FlREMMMREO'D PEAcpN <br /> STAIE Ol11lDING SUfiCHRf1GE j � <br /> TYPEOFf.pNS� PL�NS�PPROVEDOY CITYOFEVERETT runnr.wonKs f <br /> LOCAL SALES — — -;-- <br /> onte TAX CODE IS 3105 7oiAL ; "j� <br /> J�� <br />