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APPLICATIG _1 FQR CONSTRUCT . JN PERMIT <br /> CITY OF EVERETT•BUILDING DIJISION � <br /> . 3200 CEDAR STREET•EVE?'TT, WA 98201 •255-8810 <br /> �bEMOLITION ❑ COMBINATION ❑ BUILDIkG ❑ MECHANiCAL f] pLUMBING ❑ SIGN <br /> PROJECTADDR[SS:/G/p[ Ga/y/,�q/�i fj//G /�[//L �ry�;�F ��/A -�'/�20/ <br /> ON?JER MI11LApORE55 CIiY 21P PIIONE / <br /> �o�6�,r7 /yUc/��ou'iL /�10� GnMtTA,�ii .9��c:: . ��'rizETr ,_Wi9 . ��20 l ( 2�6�255-4'So� <br /> TENANT 1ANLADDRES$ Gty riP <br /> Pi�ONE <br /> �RCNITECTORDESIGNER M�IL�DORE55 ��n. ��r <br /> PNONE <br /> GElicMICONTRl1GT MMIAO�RE55 CIIY Jlf <br /> P�ION[ SUTE IICB!$E� <br /> S.ELF o wN��Z ) <br /> MECNANICA�CONTRACTOR MAILADDRE55 f.ltt ZIP PIIONE <br /> ST�TE UCENSE• <br /> PLUMBINGCONTR�GTOR MRILADDRESS �I7Y 71P PIIONE <br /> SiATE LICENSE� <br /> CONTMCT PRICE OF Wpf11( <br /> NEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WORK�ND SOUARE FOOTAGE INVOWEU f.ON1�Ct F[RSONAND PMONE NO <br /> � Ci92 G/�✓z/�G,E /o �5 . fr <br /> ( D�=/�Y!'�_ I HEREBY CERTIFY THAT I hIAVE READ AND EXAMINED THIS <br /> Vi10PO5E0 USE OFBUIIDv+G APPLICATION AND KNOW THE SAME TO 3E TRUE AND CORRECT ALL <br /> %O BU/L/ Z Ci9/2 Cs��/JG � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERiY�S WNBELOWORA �Hrw cociesl WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � /� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF �-S� ti'7D � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �v� 3/ OTHER STATE OR LOCAL LAW REGULATING CONS7qUCTION OR YHE <br /> — PERFORMANCF.OF CONbTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO FERFORM THE WORK FOR WHICH <br /> PPtiCATt IS MADE AND I COMPLV WITH THE STATE <br /> PAW;EL V Jf I.D.NUMBER .., Qp CONTRACT�1�-MW-tgp�-qQW AND 296200 WAC. <br /> �o �a1 / ��D ��L' ! �� � <br /> COIISTPUCTIpN LONI LENDER.ADDRE�S.TELEPHONE NIIM9EP x ; I Q. �_� —/�_^/ <br /> �7<c <br /> —�— SIGN U DATE <br /> CITV BUSINESS uCENSL NO <br /> PLUMBING MECHANIC4: <br /> _NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _ WATER CLOSET (TOILEn � A/C—NHNDLG UNRS � <br /> eATHTUB ; FORCEDAIRSYSTEMS � <br /> tAVATORY(WASH BASIN) � HEAT PUMP —T— <br /> SHOWER � UNITHEATERS , <br /> KITCHEN SINK 8 DISP ; CLOTNES DRYERS — <br /> DISHWASHER � RANGE HOOD <br /> LAUNORY TRAY ; WATE9 HEATER � ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> _ URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> � DRINKING FOUNTAIN ; FIREPIACE�NSERT(WOOD BURNING) ' <br /> FLOOR DRAIN ' <br /> ' GAS FIREPLACF � <br /> BACKFLOW PREVE�'TERS ; GAS RANGE � <br /> � <br /> K(SERVICE—BAR,ETC.) � GAS PIPING , <br /> EXHAUST FAN <br /> � �� <br /> � � <br /> ' — <br /> SUB TOTAL S ; SUB TOTAL E y— <br /> PERMIT S � PERMIT E � <br /> TOTAL FEE S � 'i OTAL FEE f � <br /> FOR QFF{CE USE ONLY: <br /> FROHTSEIAA�K HE�RSETBALN SIDESETB�CN P�ANCIIECKNUMOFtt fEF RFf.FIPiNO <br /> I15EIONE IOTAREA VAC�NISITE FEES <br /> VALUATION FEE <br /> _ ❑YES ❑ NO pUIIOWG ' <br /> NEIGHTUMITATION NOOFDWELpNG SREOFBLOGRI � <br /> UNIfS <br /> Pl11MpWG <br /> OCCUPANGY Iq(NSIOPoFS OGCUP�NILO�D B�SEMENi T <br /> GRWP A¢f,11nNICp1 <br /> ❑VES ❑NO .— <br /> FIRESPFiINHIERflEO'D BF�SON — �pf)IIIONq.PIANCII(.f.lc i <br /> �-- <br /> onicn <br /> FIRENA{iMREO'D PERFON <br /> SiAIE 6Uilp'NG 511RCIUfiGE <br /> TYPEOFf,ONST PL�NS�PPPC.JOY CITYOFEVERETT ruoiir,wonKs <br /> LOCAL SALES —__I__ <br /> o•re TAX CODE IS 3105 To7Al <br />