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APPLICATIc�N FOR CONSTRUC: _ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDINO ❑ MECHANICAL ❑ PLUMBING ❑ SION <br /> PROJECTADDRESS: �F�� � KICOMGR AVE <br /> �EILMpW J.�.� D�ee�� 400� �uzoNE�C AVE Q/ER,rTT Wq 98t�1 �y�s)3TS-e9�5 <br /> OMME�—� MUL�00PE55 Cltt Z�P P1qNE <br /> TE�/ MNL�DURESS CITV 11P pIqNE <br /> OkwE�. <br /> �RC111TECTd10ESIGNER 1AIULIIDONE55 Lltt li!' PMONE <br /> oWuER <br /> OENEMI CONTMLTdi YIJl�U0RE55 GTY 1�� PnONE $UTE IICENSE� <br /> _ Al/A <br /> MEpUNIC/iICONTRACTqi MAIIADOHE55 f.1TY 21P PIIONE STATELICENSE/ . <br /> u/d <br /> RU4BIN6CONTp11CTOR MNLAWRE55 Gltt SIP PIIOhE STATELICENSE/ <br /> � OC�� <br /> CON7RACTPRICEOFM/OW( - .-- <br /> a S UG? � 2c�� S7oKA46 HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRME WdiN�ND SOUAPE FOOTAGE WVOIVEU CONTACT PERSON U1D PMONE NO <br /> ST G Gax 6� 25�- PS976 <br /> JF-�f L.r�1 ,u 339- o9os <br /> I HEREBV CERTIFY TF;AT I HAVE READ AND EIfAMINED THIS <br /> ��p����p� APPLICATION AND KNOW THE SAME TO BE THUE AND COqRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lEML0E5CPIPTIONOFPNOPER7Y�5110WNBElOWpiATTACHiWOCOPIES) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> wi�eioa pF S L R wK AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TI1E <br /> @ S"r p PERFORMANCE OF CONSTRUCTION.THAT I AM AIITHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � � �� .� �� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> iNICEL I I.D.MIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTIMIL ON LO�N IENDER.IDdiESS.iELEP110NE NUMBEN x �� ���_�. �3�� <br /> SIGN� D�IE � f-��-' <br /> CITY BUSINE55lICENSE NO <br /> vw�rw 41ECMAN:CAL <br /> NO. TYPE OF FlXNHE OR ITEM FEE NO. TYPE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—AIHNDLG UNRS � <br /> BATHTUB ; FORCED AIR SYSTEMS ' <br /> LAVATORY(N/ASH HASIN) � HEAT PUMP � <br /> SNOWER � UNITHEATERS � <br /> KITCHEN SINK 8 OISP ; CLOTHES ORYERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATEH ; <br /> CLOTNES WASHER � WOOD STOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DflINKING FOUNTAIN i FIREPLACE INSERT(VJOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> EXHAUST FAN ' <br /> � <br /> i � <br /> i � <br /> SUBTOTAL S ; SUBTOTAL S ' <br /> PERMIT i � PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> i110NT5ETBGCK PE�RSETB�LK SIDESETBGCN PUNCIIECNNU ff1 ffF REf.EIP�NO <br /> 'cJ-b <br /> u5E2d+e IOT�REA VACRNISIIE FEES VALUATION FEE <br /> ❑res ❑�o ounnwc ' OO 21� ;p v <br /> 11EIGIITIIWTATION NOOFDWE4ING 512EOF9lOGRl <br /> UNIIF � PUIMOMG � <br /> u � <br /> OCGUPNILY IqpiS�(MUFS OCCUP�NTl0�0 BASEMENf MECII�NICA. � <br /> GRd1P i <br /> _ N� OYES NO — � � <br /> FlBESPRINKLEflPE '0 �iE�50N �DO�IIONq.Pl�NC11FCN � <br /> N� --r-- <br /> o����� ; <br /> FWEMAPMpEO'D AF�S(N! � � <br /> �� ST�IE BUil01NG SIIRLIUpGE �l�� <br /> iYPEOFf,ONST PLANSM DBY C' V � PIIPIIf.WORNS <br />