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A�PLICATII '�1 FO�i CONSTRUCT �N PER�iA1T <br /> CITY OF EVERETT• BUILDINL DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> p DEMOLITION ❑ COMBINATION p BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> I <br /> PROJECT ADDRESS: ,1y��'��(; ����� )IC /�' -/(,' �'� � � r,('j<El� ����G� <br /> OWNER - M�tl ESS �ITY // I�p yHpH� / ����/ <br /> ���� � �L � 'G ' �� i�P_ �.Yl/�Y(�=' •/j v � %�/C'iec-C/ ��GG/ <br /> TE�NMlT C MNL E 5 UiV ]IP FpOME <br /> ��,�'1iv1(-" c �'- l�f) <br /> A{IGNrtCCT OR DESIGNER� MIJ/ADORE55 Cltt ]iP PHONF <br /> GENEfi CONIfiA�TOR M�IL DRES$ GIY j pIIONF fA1LI1CCN5E• <br /> .� v �,� ���-� ���r�n -�l�%,����� - �� � � �q� - � <br /> _� G ! l0 /" �- <br /> LELN6NICGl CONTRAGTOR M�II ADDRE55 CII )IP P110NF SUTE t CENSE� <br /> ��� �,� ��� -�l��o <br /> PWMBINGLONfRAGTOR Y�IlA00 5 CIIY IIP pqONE ST�TEIICENSE� <br /> CONIMLi PRiCE OF M/OR <br /> — �SCi � NEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> OESCRIBE WJqN�NO SOUAqE FOOTAGE INYMVEU CONIACI PCfi50N�NII PMdlE NO �_ / // I <br /> _ Y.ti l"1 /�QCk)F <br /> G 'Z- �a <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> -- APPUCATION AND KNOW THE SAIAE TO BE TRUE AND CORRECT ALL <br /> PPOpO5EDU5E OF BUILDtNG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE C�F <br /> WORK WILL BE COIAPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEG�l0E5LRIP710NOFPRpPERTY�$NpWryBELOWORATTPG111WOCWIES� NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ior BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY <br /> OTtiER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS M�AND I COMPLY W�TH THE STATE <br /> r�nce�ux i.o.r+uueea - CONTRACTORS LAW 27 RC ND .200 WAC. <br /> � �� � =l�Cu GIS �'� r- Z 2� � , � � <br /> COHSTRULTION lON!IENDEII,AODRE55.TELEP110NE NUMPEfI <br /> 516NAt11N[ p�tE <br /> C17Y pUSINE55l�CGNSC NO <br /> PLUM81NCa MECHAFIICAL <br /> NO. TYPE OF FIXYURE OR ITeM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—MiNDLG UNRS <br /> BATHTVB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) i HEAT PUMP i <br /> SHOWER UNIT HEATEFlS � <br /> KITCHEN SINK 8 DISP i CLOTHES DRVERS <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAV ; WATER Ii[ATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfALFIREPLACE(WOODBURNING) ' <br /> DRINHING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN GAS FIRENLACE <br /> BACNFLOW PREVENTERS ; GAS RANGL" ; <br /> SINK(SERVICE—BAR,ETC J GAS PIPING <br /> IXHAUST FAN <br /> i <br /> i <br /> _' �_' <br /> SUB TO?AL f � SUB TOTAL E ; <br /> PERMII� 5 i PERMIT S i <br /> TOTAL 1=EE E ' TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> PRONTSETN�CK PE�BSET6�CR 6�.ESEIP�f.N PUNCUCCNNuu0f0 f�f f1Ff.CIPINO <br /> ❑SEIONE �or�aen vecunsnr fEES VALUATION FEE <br /> ❑YES ❑ N(1 — _ ---- T <br /> Illlll(1'Nf <br /> IIEIGII/IIMIiAT10N NO OF UWELLING 512f Uf p11K/I I ----'—'-"-"-- -"—'---'�-- -- <br /> UNII$ Pl IIMIIING <br /> — ---_.__— __-_—� ' <br /> OCCUP�NCY Iq l%SION6 OCCUPANIl0�0 BASEM@NI � <br /> GIIWP IIFC�uMCet <br /> nre; ❑ ��o — -- ------ - <br /> FIflESPfUHHLERflEO'0 RR�SON �OD�IIONALPt�NCufCN <br /> _— -__ �__ <br /> � <br /> –__— on�en <br /> FIRBr1WiMREO'0 REASON <br /> SIAI[UIIIl01NG SIIRLIUIICE <br /> iYPEOGf.ONS' P�ANSMPRJVFDAY T <br /> CITYOFEVERETT �'uni�r.won�s � <br /> LOCALSALES ---�----- .. .. _. . .. _ . .. .. ----� <br /> uAiE TAX CODE IS 3105 TOTAL ; <br />