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APPLICATIC"1 FOR CONSTRUCT`)N PERMIY <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING�J ❑ MECHANICAL � PLUMBiNG p SIGN <br /> PROJECT ADDRESS: %✓lL ��ll� J7�`"�' <br /> 01N1ER MAtUDDNE55 LITY Z�P PNONE <br /> e��E Gruz�/ i3�� [7-,e�� .9�� C-,��x�n'u�A- q�zoi zsz - ysy� <br /> iENANT NNI�UDRE55 f.IIY 71P T PNONE <br /> ARLMTEC70iiDE5�GNER M�IIA�URE55 CITY 7�� PNONE <br /> GENEMILONTMCTOii MIUTADDPE55 L11Y IIP PIIONE '•��1EUCENSE• <br /> MECHNIICI�LCONTRACTOi1 MAllA0DRE55 f.ltt TIt` PIIONE SfAfEIICENSE� <br /> PL A18WGCON NACT �ADDRE$5 � CIIY Z�P PHONE STATEUCENSE� <br /> � zi �� �/u�+cr�r,��ga��� l � �I�o� ��r-cr� D rorP�os�s+�r <br /> connu rr (jFWORK � <br /> -7—L� HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> OE�BE W011K 71N0 SWARE FOOT�iOE���LVED/ CONI�CT CF.i150N AND PHONE NO <br /> ,Cunn�n; � �j�o/I79 i(% �� �u'`i <br /> �- ��5 cJo{�.es �� �,�� <br /> �T I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 'CX/S77Nti /�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PIqPOSED USE euiano PROVISIONS OF IAWS AND ORDINAN(,ES GOVERNING THIS n'PE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> IEGALDEKRIPTIONOFPPOPEN7YI��BELOWORARACH7W0(.OPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT eiocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE OF CONSTRUCTION.TNAT I AM AUTHOHI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> P/�qLEI TAlly D•.NUMBER CONTRA TORS 1 B27 RCW AND 296.200 WAC. <br /> `�38S Z4�L D o S bts`� x ��-� ✓" / /�� 2"�-�` <br /> CONST�MICTIONLON7LENDER,�OMIESS,TELEPNONENUMBER L f��- � /m 5'L <br /> SIGN�TI DATE <br /> CITY BUSINE55 UCENS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TURE OR ITEM FEE NO. TVPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—/VHNDLO UNRS ' <br /> BATHTUB ; FORCEDAIRS'lSTEMS i <br /> UVATORY(WASH BASIN) � HEAT PUMP � , <br /> SHOWER ' UNIT HEATERS ' � <br /> KITCHEN SINK 6 DISP � / CLOTHES DRVER („�f� � <br /> DISHWASHER � RANGEHOOD ' f <br /> LAUNDRY TRAY ; WATER HFATER _ � � <br /> CLOTHES WASHER � WOODSTOVE �_ ` <br /> URINAL ' METAL FIREPUCE(WOOD BURNING) ' ( <br /> DRINKING FOUNTAIN i FIREPLA('E INSERT(WOOD BURN�NG) � <br /> FIOOR ORAIN � GAS FIREPLACE �_ I <br /> BACKFLOW PREVENTERS ; GASRANGE T_ <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING ' <br /> EXHAUSTFAN � <br /> � ' <br /> i <br /> � <br /> SUB TOTAL S ' SUB TOTAI f ; <br /> PERMIT S � PERMIT S � � <br /> TOTAL FEE S ' 70TAL FEE S ' � <br /> FOR OFFICE USE ONLY: <br /> F11pNT5ETBACK AEMSETBACR SIDESE7B�Ck rUNCnf.cJ 3��3 �EF nECFIPTNO <br /> USEZONE LOI�PEA VAL�NT511E FEES _ VALUATION FEE T_ <br /> ❑YES U NO � <br /> OUIIDING i <br /> lIEIGIIT IIMITAT10N NO OF OWEILI'IG SIZE OF BIOGA 1 � <br /> . U!Of$ P1111A01NG <br /> T <br /> � ' <br /> OCCUPANLY NO Oi SIMUES OCLUP�NT LO�D BASEMENf MEC1uNiCN <br /> GnWP --- <br /> ❑YES ❑Nn <br /> FIOE SPPINKLER REO'D �UOI I IONeI�l�N Cnf CN � <br /> RE�SON �— <br /> on�En <br /> FINEMMMREO'D pEAS(k! <br /> STAIE Ou1l�INf•SIInLIUtifE <br /> �- i"� <br /> TYPEOff.ONST �1�N5���'��1VE00Y ,•ITYOFEVERETT ��IflIIf.WO�KS � <br /> LOCAL SALES — —j— <br /> o�re TAX CODE IS 9105 TO7AL � <br />