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APPLICATIf��11 FOR CONS`Y'RUCZ `�i�i PERPiA1T <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION +[d COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJE.CTADDRESS: � 3o C- /�-Y//�ave.K/ D �^ <br /> 2e,v�o���_�i. � Mac ,"r. �wic. 4cfzY .2 � s•` /f✓� 5�= /:ie.-ett wA YSs'.2U� 3>�-2�1'q <br /> OYVI/ER � M AOpiE55 CITY ZIP PIION[ <br /> IENANT MNlADd1E55 f.I7Y TIP 1`I�ONE <br /> ARCMT[�TOfiUE51GNER M�IL�DORE55 CIiY ]If' f'110NF. <br /> �Q�En o�PP�iw-o Mac�-i� i�dc 4'929' 3�sr7�vi= S��v_�'r�r�'�u/A 48'.z v s- 338' .:: 7 7'� <br /> GENEfIqCONTP�CTO MIJLADDRESS GIv IIP P110NF. $fAIEUCENSE� <br /> 1AELHANICALCONTRACTOR MAILAODRE55 LIIY IIP PIIONE STATEUCENSE� <br /> PWMtlINGCONiRACTOR MAILAWRE55 CIIY 21P PIIONE S1ATEtICENSE� <br /> CONTq/�T PRICE OF wORN <br /> 7 � �OG' NEATING SYSTEM: ❑GAS 1�ELECTRIC ❑ _ _ <br /> DE'iCRIBE WOi1N AND SOU�RE FOPTMaE INVOIVED GONUCf PERSON ANO P11011F.NO <br /> /nCoc� S,�-� A/�c2/ �d /-'"� <br /> � � <br /> I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br /> vnoroseo use ov euadrvo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT ALL <br /> PROVISIONS OF LAWS AND OR�INANCES GOVEfiNING THIS TYPE OF <br /> /`' WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�L0E5CP�PTIONOFPFIOPERTY�51qWNBELOWOR��T+7�/c�/,rwo/c���rrr,iEs� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tor�e�ocK oF v �"• � ���� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION nf ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION l.'t THE <br /> S ,e Q �L,� �o� PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> wwee�i�x i.o.rruueen . CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 5 fc�.l� oon�-ro.� 5'�5'(j -ar�0-ol3-oio�/ - �J <br /> LOIW L DEH.�7DRE55.TELERIONE NUMBEfi Q�.ClYy� ��a..-J,��J I '3 O q � <br /> n �7�-a ' x <br /> �vA/��✓L/OC�,^3' I�IfII���� `�� �/3�� SIGNI1TUf1E DAIE <br /> Q aCi �B C7 <br /> (So5-�18' r,SrS'�✓�,�NNK�ood' 9$Qy3 CIIYBUSINESSIICENS[NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—MiNDLG UNRS ' <br /> I BATHTUB ; FORCED AIR SYSTEMS ; <br /> �_ LAVATORV(WASH BASIN) � HEAT PUMP � <br /> j SHOWER ' UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS � <br /> DISHWASHER � RANGENOOD � <br /> UUNDRY TRAY ; WATER H[ATER ; <br /> CLOTHES WASHEH � WOODSI�OVE � <br /> URINAL � MEfAL FIREPLACE�NOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RANGE i <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> DCHAUST FAN ' . <br /> � ' <br /> � ' <br /> � ' <br /> � T <br /> SUB TOTAL S ' SUB TOTAL S ; <br /> � <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE E ' <br /> FOR OFFICE USE ONLY: � %�/Z _ �t . UJfi1v ��7t�0/ • <br /> iRONTSFTN�CN PEAqSEiBALK SIDESE7B�f.M 1'I�HCIICCRNUuOf(1 fff G �3 �ff.flPiNO <br /> 2o su s�n v,..�a 5_ v'�y//D 0'`�' <br /> OSE 20NE l01�fIEA V�CANI SIIC FEES _ VALUAT�ON FEE <br /> ��' � /0 �/2 7 evEs ❑uu nun nwr. — -- .8�` - --�'- �Z 1�� <br /> IIEIGIII IIM�TATION NO O�bWELIING size or nux:n i —'-- � <br /> Z(�� UNII$ O 1•I IIMIIIN({ - ___ <br /> � O �' S.f. --__ -�-j— <br /> OCCUVNlLY Iq 0�SIOPoCS OGLUPANf IO�D BA.EM[NI MEC11Maf.�l _ _ __ lnQ ; <br /> GRCJP _ _ <br /> n.cs n�,u — -- ___ . <br /> F/IfiE5P01NNLERREO'� RFASON . — �OD�IIONALPI�NCufGN — —_- <br /> - G L�Z���___r % �Y1� _ � qu�tn ; <br /> f IMREO'D RE�SON � <br /> S1AIE flUIl01N0 SIIRf.����0E — — '�/1 <br /> � <br /> rvrE or r.or+st oinNsenrnoven ar CITY OF EVERETT rum ir.wonns __2��_ <br /> LOCAL SALES - -- -- — -7 <br /> o�ieZ 2 �t7 TAX CODE i�3105 T07n1 ----- ----_ ------- � `7� �/8 <br />