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APPLICATIO.�+ FOR CONSTRUCT'►�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVEHETT,WA 98201 •259-8810 <br /> ❑ OEMOLITION �OMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SI(3N <br /> PROJECT ADDRESS' �('iU ?_ CT i'q.i �� .Q✓� <br /> /�9�'//P�� i�rc� /��z �'T.aK�,s'�v E�p �1� 303 -�'3 9l d 3�3- 7U93 <br /> p�Eq MM11100PE55 Cltt Zir PNONE <br /> TENMlT MAII�WH[55 f.l7Y t�P P110NE <br /> A/RL�HITEGi Oi10E51GNER M�II/iD�RE55c / Cltt �(t/ 711` Pd9NE C �A /�/�(/� (� <br /> 6ENER l dl R�CTd1 O.� uO�lCS!/ �f�pNl.�(G�J SP �//(P ��?' � p110NE�/9/ �/' 'S/!/C IO S�� <br /> C��QP.v wuev�yl.�Q° /-P%'�if'/o.,� �S�'/y5� <br /> MECN/�NIC/�LCONTR��(CTOi/i / MNLADORE55 Lltt IiC PIIONE STATEL�CENSE� <br /> �PS�'911�r/P�(G✓�'7i� �1��"��7� <br /> PLUMB CONTRI1CTpi MLAOORE55 LI�Y 11P PNONE STATELICENSE• <br /> "o ao v <br /> caNrruc aa wa+K <br /> L� r v �✓qfv � 7!l 5l�.yPy HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> � Wpql(11ND RE�i�/1�OT E MlVOIVED D CO//�T�CT PE`9'SON�ND FNONE N✓O1 / /y�/ - <br /> �M N/ / �I RS I�✓-�/l.E� Oi. GI f0� /\ ` C'I �7 Q' SY�SIl�O�1� �� � �/ • �� <br /> � ` �. a� G✓ a� �i/o '�O'PGv„ r. <br /> vl /C /00 -P � 5 dw r / C.P q,' a,f � HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KN01V THE SAME TO BE TRUE AND CORRECT ALL <br /> � PROVISIONS OF UWS ANU ORDINANCES GOVEHNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITri WHETHER SPECIFIED HEREIN OR <br /> �EG�1LpE5�(tlp11f7t1pFp�qPERTY(SIqWNBELOWOqAT7ACNIWOCOPiES� NOT. THE 6RANTINO OF A PERNIT DOES NOT PRESUME TO 61VE <br /> io1 eiocK oa AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI LAW RE6ULATIN6 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 /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r�nc�i T�c i.o.�q CONTRACTORS LAW 18.27 HCW AND 296200 WAC. <br /> CpN$TRUL110N LOAN LENDER.AODRE55.TElEP110NE MIMBEP X�� - ��"'��' / ����/ /��� <br /> SIGNATVRE DATE <br /> LIIY BUSINESS I�CENSE NO <br /> p���Np IAECHANICAL <br /> NO, TYPE OF FlXTURE OR tTEM FEE NO. TYPE OF EGUIPI�AEMT FEE <br /> � WATER CLOSET(TOILE� � NC—NHNDL6 UNIi5 ' <br /> Z BATHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP ' <br /> / SHOWER ' UNIT HEATERS � <br /> � <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS ' <br /> DISHWASHER � RANGE HOOD ' <br /> ' / WAiEfl HEATER � <br /> LAUNDRY THAY � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' MEfAL FIREPUICE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSEFiT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING '— <br /> � IXHAUST FAN � <br /> � <br /> i � <br /> � � <br /> � <br /> SUB TOTAL S ' SUB TOTAL f � <br /> � <br /> PERMIT S i PERMIT f � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> i110NT5ETB/�CK REARSF.TBACK SIOESETB�Ck %ANCIIECKNUMBFR fEF PFCEIP7N0 <br /> uSEzor�e LOTARE� ��CANf51TE FEES VAIUATION FEE <br /> ❑YES ❑NO , 7 � <br /> eu�inn+a <br /> NEIOHT UTAITATION MO OF AV�ELLING SIZE OF BIOGRI � <br /> UNIfS PIUMBING <br /> � <br /> OCLUPMICY Iq O�SI(MYFS OCCUP�NTlOAO BASEMENf MECM�NIC�L � <br /> GRIX1P i <br /> ❑vE5 ❑NO � <br /> FlRE SPWNKLEfl REO'D <br /> RF�SON �DpIIlONA1Pl�NL��F.Ck i _ <br /> � <br /> OiNER <br /> FlliEAURMREO'D REACON 1�� <br /> SUTE OUIlD1NG SUOCIURCE �✓ <br /> TYPE Oi f.pNST �IANSAPPROVED BY CITY OF EVERETT runnr,wonKs � _j_ <br /> LOCAL SALES ' <br /> D�TE TAX CODE IS 7105 TOTAL ' <br />