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APPLICATIO.. �OR CONSTRUCT��N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> . 3200 CEDAR STREET•EVERETT,WA BB201 •259-8B10 . . <br /> ❑ DEMOUTION ❑ COMBINATION ❑ BUILDING J� MECHANICAL ❑ P�UMBING ❑ SIGN <br /> PRWECT ADDRESS:_ <br /> �L��(c' '�ZL/GT k.l�S� � \ <br /> OMNER wulAWnE55 atv 1m <br /> .s�^^ FiA�i-N�! �'7iS IOoT�-1 �G� S� �uF1'�ry" `�3T�' 3�a Zlr �l <br /> TEWWT 4MLI10DIIE55 GIY )�p p�p� <br /> ANpM7ECTORDE516NEq MAIIMDRE55 CITY lll' PMONE <br /> GENERAIGONtMCTOR MNtAWilE55 GI/Y jIP PIqNE SfqEIIGfNSE/ <br /> MECNIIN�CALCONTRACTOR MNL�Dd1E55 GTY il� P11pNE STATElKENSE• <br /> �2 <br /> PLU4lRM�CONTMCTOR YiULA00liE5S CITY IIP V/qNE STAfEIICENSE� <br /> TRII�T i1MCE OF W WII( <br /> - ZQ�, �� HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> oeaca�E woaK iwo snwac FooT,�a�Nvaveo corrt�ct r¢nsor�ua v�qo �E �Z�(( <br /> /,tl*� �/�✓ c�lT �- �^ E <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED TNIS <br /> vrarosEo use oF euupNa APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED MEREIN OR <br /> �[ckoesewvrwNOFrnoaEan�s�qwneeiowoq�n�cHtwoeori¢s� NOT. THE aRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eioac oF AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY <br /> OTIIER STATE OR LOCAL LAW RECaULATIN6 CONSTRUCTION OR THE <br /> PERFORMIUJCE OF CONSTRUCTION.THAT I AM AUTHOH¢ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> NWLELTNf I.D.Ml1lER CONTRACTORS LAW 18.27 RCW AND 286200 WAC. <br /> CONBTIM1C710NlOANIENDER.ADDRE55.TELEP110HEMNMER y��/.J�� / /—� !//�/-/�+ <br /> SIGM Uf1E p�7E � <br /> GfY BUSINESS IICENSC Np. <br /> P���� MECHANICAI <br /> NO. TYPE OF FlXTUqE OH ITEM FEE N0. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLa UNfTS � <br /> BATHTUB ' FORCED AIR SYSTEMS ; <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT MEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRV TRAY ; WATER HEATEfl ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN , FIREPLACE INSERT(WOOD BURNING) � <br /> ROOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS P�PING <br /> ' EXHAUSTFAN ' <br /> � <br /> i � <br /> � � <br /> � � <br /> SUB TOTAL S ' SUB TOTAI S ; <br /> PERMIT S � PERMIT S � <br /> TOTALFEE t ' TOTAIFEE S ' <br /> FOR OFFICE USE ONLY: <br /> iHONTSEi&ILI( PEMSETB�LN SIDESETlACK PLANd�[Ck�. ����1'R � FEF RECEIPTNO <br /> usEzor� ioue¢n v�cuirar¢ FEES VALUATION FEE <br /> ❑YES ❑No T— <br /> BUI�pIHG � <br /> � <br /> Hs.LNT IIMITl1T10N NO Of DWELlINO SIIE Oi BLOGIf.I � <br /> UNIIS PLIIMOING � <br /> — - � <br /> a�PANCY NO Of SIMFS OLCUPANi�O�D EASEMENf MI �MIC� � � <br /> i <br /> OYES ❑NO --' ' " <br /> FIPESPWNNLEflREO'D RF�SON �I �t(IH�I i�lCK i <br /> � — �j�- <br /> Ol l l@R � <br /> FIHENMMflEO'D PEASp/ — - <br /> � <br /> titAlE. :,IIOC11�fiGE i <br /> � <br /> �� f� <br /> TYPEOFf,pNST PLANS�PP110VEDBY CITYOFEVER�TT Pllfllif • <br /> LOCAL SALES —�— <br /> o��E TAX CODE IS 3105 TOTAL � <br />