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APPLICATIOr� FOR CONSTRUCT�JN PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETi,WA 98201 • (425)257-8810 <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: 07�U x. �il�(�.�� � <br /> ,�S QbHA � �TP�'c r�� 9a�3 �-�� .s t sc .G•f- 9gzas s3s s��s <br /> yyHEq M�AODRESS CITY I�� PHONE <br /> ,� /j7nr�c•�- �e.rUic� �r�- �vtnc7� �l8Zo/ �Sg-o8� 1 <br /> 1ENANT MIUL�DDFF.55 LI7V DP PIONE <br /> �RCNITF.GT OR DESIG' � M�IL��ORESS � WfY '//� ��/ONF <br /> ���F-� �oNsT2ucl1�J1� �5,�5 13��er/� �✓.���f} a 9�zoi ,�1�,ec�:xa��L2, <br /> , cnv nr � rnove crnte icense� <br /> ENER�L onTeecra+ M�II��U�E55 <br /> MF.CH�NIC�LCONTAACTOR MAI�ADDAES$ C�T�' 2��' PlIONG STAiF.UCENSE� <br /> PIUMBINGCON7P�f,TOR Me1L�DORESS GITY Z�P PNONE STATEUCENSF� <br /> or+T�nCI PRICE OF�a,Jc HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> DESCI IB RK ANU$OU�AE FOOTAGE IN O`VED " / � GONT�CT PFPSON ANO�IIONE NO <br /> S v� � <br /> /1 FN � � �32 � � <br /> I HEREBY CERTIFY THAT I HAVE REAO AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSE.D USE OF Bl11lU1NG PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> � io'r,�1sGpjpa�OFB�PEqtt�SNOwNBELOWON�TTACNiWOLORE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> J7� i�oF�� 5 y� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> 1 -� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> � w OWNEF OF TI IIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE A'JD I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RGW AND 296200 WAC. <br /> PMCEL TA%I D.�1M9ER �,/�/��J/� / <br /> GONSTPIICTIDN101�NlENOEP.�DD�E55.TCLEPHO':i•��'.�BER �(�A/�'��/� - - ���// � <br /> �GNATURE ���� <br /> CITY BUSINE55 LICENSE NO <br /> PLUMBING MECHIIN�CAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HN�LG UNITS � <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNIT HEATERS � <br /> KITCHEN SINK 8 OISP � CLOTHES DRYERS ' <br /> DISHWASHER � W TER HEATER � <br /> LAUNDRYTRAV ' , <br /> CIOTHES WASHER , ME A�L F REPLACE(WOOD BURNING) ' <br /> URINAL ' - <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � _ . . ., ��-!'R'x� <br /> � GAS FIREPLACE � <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GASRANGE ' <br /> SINK(SERVICE—AAR,ETC.) � GAS PIPING <br /> � EXHAUSTFAN � <br /> � <br /> � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL E ; SUB TOTAL 5 � <br /> PERMIT 5 � PERMIT S � <br /> — TOTAL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: �EF necFmrNo <br /> fpONTSfTPACK RF��SFIB�CK $IOESEIB�CK PL�NCIIEGRNUMflfR <br /> IOI�REA FEES VALUATION FEE <br /> VSC�NT 9tE ---T— <br /> 115[ZONf ❑YE$ ❑ NU — f� <br /> OUIIOMG <br /> _�.��.�- <br /> HEIGIIil�41TAlION R011O�UWELUNG $�2EOfBLOGR� p����yM6 __ _ __ , � <br /> 1//l —T-- <br /> i <br /> NFCN4MGl � <br /> OCGUP�KCV NO 04 S��RikS OCCU�'�Nl IO�U B�SFMENI _ <br /> GVi / A �� ❑VE$ NO _ _- � <br /> � /l/ � <br /> �DDI IIONM.Pl�N CrIf.GK ; <br /> fIPESPPINICLERPEO'0 �F�SON ----�-- <br /> p OtNE� " / <br /> FIfVE A RM REO'0 �F���� _'V_U <br /> - , 5fq[OIIIl01NG$UPCIUfIGE <br /> �rreo o�sr rLnNS�n ovEnor CITYOFEVEREIT runiir.vmnKs __ 1 <br /> I / � LOCALSALES ` — �— <br /> �/ � � oArE . � � -S� TAX CODE IS 3705 TO7AL _ _ <br />