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APPLICATI(-Y FOR CONSTRUCZ ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATIO�NI ❑ BUILD G ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: /DI� ( /��� <br /> OR, lRi�/Nb- +1"BEfi'1 ✓ARr�Y� /OIS �ROwN'� � ��['b7]-, u��4 98zo3 z5z- LS t7 <br /> OVRIER MUL 55 C17Y Zi � PNONE <br /> SfyiN G <br /> TEIUNT �NL�DDRE55 CITY ZIP P11ONE <br /> Pt�10�1�A,��.vua ,�i9� s, 3'�Ad� dk �✓,r��Tr w�• �Atia3 z52-a3�6 <br /> NiL111TELT ON DESIGHER 4611 AIX1RE55 CITY IIP PIIONE <br /> ,V oN ��✓5%R• <br /> 6ENEMlCON �GTOR MNtADDRE55 CITY ZIP PIIONE SfATEIICENSE� <br /> YECIII�NICALCONTRACTOi1 MAIL�WRE55 LITY IIP PIIONE STATEUCENSE� <br /> MUMBMIG CONTRACTOiI M�II ADORE55 CITY 21P PIIONE $TATE IILENSE� <br /> CONTMCTPRICEOFWW�N L ,Jp/� HEATINGSYSTEM: ❑GAS ❑ EIECTRIC l� U�L <br /> "/D <br /> oeuweewonu�rasouu�vooTnceir+vaveo cor�i�cr ep-s��nrAeno � 'fui –7�t'12�a3T�o <br /> ! � �� <br /> i ` v4 � 2 a , '�s ,�Dvrrn� <br /> �L 2"I d� � Q, r'�,L 1 HEREBY CERTIFY THAT I HAVE READ ANO E%AMINED TNIS <br /> � F � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> rroroseo useA o'F eu�anLod.� PROVISIOI�S OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> S!'y�� / /�/,,IG`� �j�LS��LNG�i WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �EOI1LpEuq�pTlONp�p{ppEp7y�51qWHBELOwIXiATTACHTWOCOMES� NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> iot�B�� �_ AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTIiER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � Q � Q .- - � PERFORMANCE OF CONSTRUCTION.TNAT I AM AUTMORIZED 8V THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> - CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> PAIILEl7lUlID.IUTABER ��� <br /> U � ,l� d.s��� 5�a/9� <br /> �${q�ilON IOAN LENDER.AWRE55.TElEP110NE NUMBEN <br /> SIGNATU�'7E� � <br /> CITY BUSINE$$LICENSC NO <br /> �V��� MECHANICAL <br /> Np, TYPE OF Fl%TIi�E OR ITEM FEE NO. TtlPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET� � A/C—A/HNDLG UNITS ' <br /> �, BATHTUB ; FORCED AIR SVSTEMS � <br /> IAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER <br /> � UNIT NEATERS � <br /> KITCHEN SINK d DISP ' CLOTHES DRVERS ' <br /> � <br /> OISHWASHER ' <br /> RANGEHOOD ' <br /> � WATER HEATER � <br /> LAUNORY TpAY � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL <br /> � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(VJOOD BURNIN.1 � <br /> � GASfIREPLACE � <br /> FLOOR DR,�IN � <br /> � GASRANGE � <br /> BACKFLOW PREVENTERS � —'—� <br /> SINK(SERVICE—BAR,ETC.) � GAS PIP�NG <br /> EXHAUSTFAN � <br /> � � <br /> � � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL S ' SUB TOTAL f � <br /> � <br /> PERMIT f � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: � <br /> 3� aer.�mrNo <br /> f110Ni5ETBACN REMSF.TBAGM S�DESET��LN PlA�C11ECKNUMOfR rrF �9y��� <br /> 20� t�� s -s <br /> FEES VALUATION FEE <br /> USEIONE I tOTenEA V�C�NISIfE � /�, --'T/��}' <br /> �� �/JJ1 7'3'S � ❑YES � pUIl11INC 7l1 ...J Z� � i ✓ � <br /> ✓ 1 � I �J ' J <br /> NEIGIIT L�NIT�T�N `NOI OF CNEILING SIZE Oi BlOG41 � <br /> Lq � 4�� Sf� riuun�r�c OO <br /> � <br /> OCCUPANCv NO Of 5�(�[S OCCUPAM\O�D BASEMENI � MEOUNIGI __�S!O� <br /> �„P Z — --- , <br /> ❑YES O � <br /> �UD�IIONq.Pl�N CIIf CN <br /> FIfiESPRiNNLERREO'D I1F�SON �T- <br /> OIIIER � <br /> � <br /> ",E NMM REO'D PE�SpN � <br /> / � <br /> ST�IE OUIl0iN65110C�1�OGC � <br /> � <br /> __ t <br /> TYPE OFf,ONST �L�NSAPPPOV[OOY CITY OF EVERETT �`��Rl lf.WOPNS <br /> LOCAL SALES ----- ��-1� <br /> i���E C V q� TAX CODE IS 3105 70TAL � --� J� <br />