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APPLICATI�1 FOR CONSTRUC ��N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION Cl COMBINATION fl BUILDIN(i �S.IMECHANICAL f1 PLUMBM�Ki ❑ SKiN <br /> PROJECT ADDRESS <br /> pyy�[q MML�OORE55 CITY ZIP PNONE <br /> �. 0 �e�� ����+ �;, - � ��a �f�� � A,�� - �,�,�,� �i�. �; ,����� _ <br /> iENANT MMl�00RE55 CITY ZIV P110NE <br /> Fi/!!'L �' �.t �n�ci�n/Vl �Lrc.u [ �?���C) /-/f K.�'1� Q �i - tuli/� '3n �-�/7/ 7 <br /> �ncMTcctaaoesronea M�aooness —�- an zm v�wNe <br /> GENERALCONTRIICTOR MNLI100i1E55 CITV 21P PNONE SiATEl10EN9E� • <br /> yEp��MCKCONTq11CR1R M�IL�DOR/ESS G CITV ZIP PHONE ST�Ti:ICEN'9E/• Mri �� <br /> �YH/T1 �'rL S✓<llmt yS� / sd �(���tnrr.� �� � tc �-n • � wJl. Sx�,C Y73-C,�/�e7 <br /> p�U.eRpCONTphCTpR M 1100RESS CITY ZIP PNONE ST�TELICEN9E� <br /> c�""�cTrroc�°F� HEATING SYSTEM: C]GAS ❑ELECTRIC ❑ <br /> pE$pN�E WpN(�Np SIXIARE FOOTAOE �ED CONTACT PERSON AND PNONE NO. <br /> T� < 5 L".,, �!'� - <br /> � / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 0 APPUCATION AND KNOW THE SAME TO BE TRUE AND OORRECT.ALL <br /> � pqovo�o us�o�a�ao�+ pROVISIONS OF UWS AND ORDINANCES OOVERNINO THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETIIER SPECIFlEO MEAEIN OR <br /> �cu�pesawrqnoFvr+ovEq +owne�owa+�rr�cHrv+oco�Es� NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUA� TO OIVE <br /> �� �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVtBION OF ANV <br /> OTHER STATE OR LOCAL LAW REQULATINO CONSTRUCTION OR TME <br /> � PERF M11NCE OF CONSTRUCTON.THAT 1 AM AUT?10AIZED BV TME <br /> O R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> ' APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> , CONTRACTORS LAW 1827 RCW AND 288200 WAC. <br /> . . MAC671Uf I D.MIMSER <br /> .. � . . CON�IIRIC1qN LOIW lENOER.IIOd1E33.7ELEPlqNE MIMlER x _��•.��� / -/��5 S- <br /> si � ouE <br /> �3s�� <br /> . a.r eusrc+�ss i�c�sE No. <br /> ��q MECHANICAL <br /> . � N0. TYPE OF RIfTURE OR ITEM FEE NO. TYPE OF FlXTUiIE OR ITEM FEE <br /> � � WAifR CLOSET(TOILET) � A/C—AMNDLO UNITS—H.P. ' <br /> �� � ' g���g ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UVATORV ASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNITHEATERS-B.T.U. M ' <br /> KITCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> DISMWASHER � VENTILATION FAN ' <br /> UUNDRY TAAV ; RANQE HOOD � <br /> CIOTHE3 WASHER � WATER HEATER ' <br /> � URINAI ' WOOD STOVE � <br /> ORINKINO FOUNTAIN � METAL FlREPLACE(WOOD BURNINO) � <br /> FLOOR DRAIN � FIREPUCE INSERT(WOOD BURNINO) ' <br /> BACKROW PREVENTERS ; OAS FIREPUCE � <br /> SINK(SERVICE-BAR,ETC.) � OAS RAN6E ' <br /> � OAS PIPIN6 � <br /> , E%HAUST FAN ' <br /> i ' <br /> � SUB TOTAL S ; SUB TOTAI S ' <br /> PERMIT S � PERMIT S � <br /> - TOTALFEE S ' TOTALFEE E ' . <br /> FOR OFFlCE USE ONLY: <br /> FppNT SE�g/wy( REAR SETBACK S��E SETBACN PUN CNECK NUMBEP FE`�� �J!' RECEIPT� <br /> 7 j — Z <br /> USEZONE LOTAREA VACANTSITE FEES VALUATON �E <br /> f1YES ❑ � Bl11LDIN6 <br /> HEqNTUMITIITON NO.OFDWEWNG SIZEOFBLDG/fl. i <br /> UNITS �'6' ^ O� PLVMBINO <br /> L•V <br /> pCCUPANC� NO.OGST(NUES OCCUP�NTlOAO BASEMENi MECNANIGAL <br /> P 2 52 <br /> nres ?ewo I <br /> ADDIPON�L PUN CHECK <br /> FlREAIARMREO'0 REASON <br /> 4� olza'�uAtiY,� ' <br /> OTNER � � <br /> FlRE SPyRyIN�KL�ER REO'D REA�SO�Nry <br /> lftt'1 OPVAN � � SiATEBl11LDIN SUR�;H�RGE � <br /> i <br /> �YPE OF CONS[ PUNS APG1RAOVEO BY CITY OF EVERETT PUBUC W�RKS � <br /> � �N' / TAX CODE I^S 3 05 TO7AL � <br /> DATE � �3 �7 <br />