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APPLICATIOti FOR CONSTRUCTI.�N PERMIT <br /> CITY OF EVERETT•BUILOING OIVISION � <br /> 3200 CEDAR STpEET•EVERETT, WA 98201 •259-BB10 <br /> ❑ DEMOUTION ❑ COMBINATION p'BUILDING ❑ UIECHANICAL ❑ PLUMBING ❑ SIGN <br /> P OJ CT ADDRESS: j'�Z t./ ���.� A�� <br /> � <br /> `��t� l � �4 5,4 E Crit i �71 w�4 �YS z� / 2S9 7 z 9 � <br /> MNL�OORE55 C�tt � IIP PNpNE <br /> TE/UNT MNLAOOqE55 CITY 71P 1`I�pNE <br /> M�1�MfECT pq pE51�11�ER � /-MNl�DdiE55 Gltt IIP P1qNE <br /> //,.�v� � /s'l"JL+V _ <br /> CiENEMlGp1TMLfqi. MNL�WIiE55 <br /> ���� IIP P110NE Sf�tEIICENSE• <br /> MECNAN1CµCpHTp�CTp1 MulA0p1E55 f.itt DP PHp�E STaEUCENSE� <br /> RVAlMIGCONTR�CTOq M�IlA0qiE55 CIfY 21P PIqNE STATELICENSE• <br /> coxrrucr w�oc <br /> � O aJJ f:Cj' C� HEATING SYSTEM: �GAS ❑ EIECTRIC ❑ <br /> UESCR�lE WpIKANO Sq1MlE FOpT110E N1VOlVED //�� CdITACT PERSq�µp PIqHElp <br /> r^J OSf" Y /� 'llJn � 1Jn <br /> _r�.5i.�« U;�-�, Sa�a d �'��Sy-� � <br /> I HEREBV CERTIFY THAT I NAVE READ AND EXAMINED THIS <br /> wioroseo us¢os eutpra — APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ���� PROVISIONS OF UWS AND ORDINANCES GOVEFNING THIS TYPE OF <br /> ��uo��c^�vnor+araor�nn'iyawneeiowoa�rt�cHTxocpn¢s� W�RK W��� BE CAMPLIED WITH WHETHER SPECIFIED NEREIN OR <br /> �or 2 1 �� N31 � /, �•��� vPJ-G� AUTHORIT� TO V OL�AOH CANC�THEO P OVI&ION OF AINV <br /> OTHER STATE OR LOCAL LAW qE6ULATINO CONSTHl1CT10N Oq THE <br /> PERFORMANCE OF CONSiRUCT10N.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PfiOPERTY TO PERFOqM THE WORK FOR NMICFI <br /> APPLICATION�t�MADE AND 1 COMPLV WITH THE STATE <br /> wwc¢�i�i.o.M�q CONTRACTO'RS LA M.p7 AND 2g6.200 WAC. <br /> 9 / �i3 / ovv/ <br /> CONSTRIICTqN lON1 LENOER.I10d1E5$.TELE%IpIE IIU1lER x � c�-� Q /J <br /> U <br /> ��T� D�TE <br /> CITYBU51NE56 ENSENO <br /> ��� MECHANICAI <br /> M0. T1�PE OF FlXTURE OR ITEM FEE NO. TypE pp EW�11T FEE <br /> _ WATER CLOSET(TOILET) , �_�Q� <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASM BASIN) � HEAT PUMP , <br /> ��R ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORVERS ; <br /> dSHWASHER � R/WGE Fi00D , <br /> • UUNDRY TRAY ; WATER HEATER � <br /> CIOTHES WASHER � WOODSTOVE —�- <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKIN6 FOUNTAIN ; FlREPUCE INSEFiT(WOOD BURNING) ; <br /> FLOOR DRMN � 6AS FIqEPLACE � <br /> BACKFLOW PREVENTERS ; (iAS RqNGE � <br /> SINK(SERVICE-BAR,ETC.) � GAS pIPING , <br /> ' IXHAUST FAN <br /> � � <br /> � � <br /> � , <br /> _ SU9 TOTAL S ; SUB TOtAL f ' <br /> PERMIT S � PERMIT f � <br /> TOTALFEE S � TOTALFEE f � <br /> FOR OFFlCE USE ONLY: <br /> ���TSET11AGf RE�RSETl11CN SIDESETBACK Pt�NC11ECNM/MBFR � fE�� ^ RFf.FIPINp <br /> �as 5 ,, :�� <br /> USE 2p1E lOT�REA V�C�Ni SIfE FEES VAlUAT10N FEE <br /> ❑YES ❑ M1 BUIlU1N@ D � <br /> � � <br /> 11EIGNTlIM1�TION NOpFpW[LLIN(3 �I � <br /> . 1E OF SL06/f I <br /> UNIfS � <br /> �:XI(7,�7 P���MBING <br /> � <br /> OCCUG�NCY 1q(x S�(wE5 OCCVP�Nf LO�D � <br /> Gf1IX1P ���NT �� MECN�NIG�I � <br /> ❑YES �NO <br /> flRESPHIHKLEqREp'D AF1150N �DD��IONM.MANCNfGM � <br /> 0111E{I i <br /> FIRE�IARMREO'D RF�SpN � <br /> ST�I[BUIIOMO SVOCN�RGE — '��/'� <br /> 1LL1 <br /> TYPEOif,pNST P�ANSAP�ROVED r CITYOFEVEREIT PIIAIIf.WORRS <br /> �, I .� LOCAL SALES <br /> N o�re TAx CODE IS�105 TOTAL ; �J-' <br />