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�d�. 3L= l�/f5 /c � /o � � � <br />APPLICATION FOR C�NSTRUCT�UN PERMIT <br />CITY OF EVERETT • BUIf_DING bIVI510N � <br />3200 CEDAR STREET � EVERET7, WA 98201 • 259-8810 <br />❑ DEMOLITION <br />ADDRESS <br />CC�MBINATION fit BUILDINQ k] MECHANICAL <br />� 5 c,Jyfi �+�t,� ll pr1� <br />kl PLUMBINQ ❑ SION <br />Rwlcvt prniac_ 7nr 77R71 Btt AvP_ W�A-201 �IerefF FIA 96204 ,7,Q(�513-90f16 <br />IENAN� r MI11lMUf1E53 CIIY . 21P CIIONE <br />AfIC111IECtOqUE51ONEfl M61LAb00E55 CIIY 21P P110NE — <br />OENEMLCONiR4CTdi MAI�AOOIlESS CIIY iIP pIIONE SUUELICENSE� <br />. -"' ••• rnvne SIq�EUCENSEI <br />PLUMBklOCON�p�Tpl MAI��ODRESS CItV 21P p110NE STAIELICENSEI <br />INVOLVEb <br />�or S e�� <br />tNc i.o. <br />��S zia'� s�. <br />PLUMBINO <br />TYPE OF FIXTURE <br />WATER ClOSET (TOILETI <br />FLOOR DRAIN <br />BACKFLOW PF <br />FOR OFFICE USE ONLY: <br />FRONTSE79ACK f1ERfI5E18ACK <br />'� � 20 � <br />USEZqNG� �M IOTARE� <br />3 T �oz< <br />IIEIOIITUMITRTION � NO.OFOWELLINU <br />.� yZ . uwrs � <br />ttPE <br />-iJ I unie <br />HEATINQ SYSTEM: bq OAS f] ELECTRIC ❑ <br />CONI�Ct PEtl50N ANO PIIONE NO. <br />I IiEREBY CERTI�Y THAT I HAVE FEAD ANU EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PHOVISIONS OF IAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br />WORK WILL BE CUMPIIED WITH WHETHEfl SPECIFIED HEREIN OR <br />NOT. THE OpANTINO OF A PERMIT DOES NUT PRESUME TO QIVE <br />AUTHORITY TO VIOLA7E OR CANCEL THE PHOV�SION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CON3TRUCTION OR THE <br />PERFORMANCE OF CONSTRUC710N. THAT I AM AUTHOqIZED BY THE <br />OWNEq OF THI9 PROPERTY TO PEHFORM THE WORK FOR WHICH <br />APPLICAiION 19 MADE AND I COMPLY WITH THE STA7E <br />CONTqACiORS lAW 1827 RCW AND 288.200 WAC. <br />Selec ]anes, IncQ. <br />Xav: �u'f.R� G Z([ �� <br />SIONI11Vf1E O� E <br />CIfV BIIS�NE55 UCENSE Np, <br />FEE NO. iYPE OF FIXTURE OA ITEM � FEE <br />� NC — AMNULO UNITS — H.P. <br />' FORCE� AIR SYSTEMS — B.T.U. M E.A. <br />� HEATPUMP <br />� UNIT HEATERS — B.T.U. M <br />� CLOiNES DRYERS <br />—;— '� VEN71LAtION FAN <br />� RIINOE HOOD <br />i WA7ER HEATER <br />' WOOD STOVE <br />� METAL FIREPLACE (WOOD BURNINO) <br />� FIHEPLACE INSERT (WOOD BURNINO) <br />� OAS FIREPLACE <br />� OASRANOE <br />' OAS PIPINO � <br />i EXHAUSTFAN <br />i <br />i <br />— —�---r— — <br />i <br />S � SUB IOIAL $ <br />S i PEIiMIT E <br />E —~ TOTALFEE S <br />SI�E SE78�A'.0 � PUN CIIECK NUf�IB� � C^ FEE RECEIPT NO. <br />`10 ! <br />VhCANT${TE FEEB VALUATION �FEE <br />O NO <br />❑YES FPNO <br />BVILbINO <br />'f FIUMBINA <br />MECHnNIC�I <br />IIUbIIIONnL I'LAN CIIECN <br />OIHEf1 <br />SIM1IE OUILbINU SUfIClI�OOE <br />CITY OP EVERETT nuauc wonks <br />LOCAL SALES <br />TAX COOE IS 3105 70tA1 <br />r <br />