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�. <br /> APPLICAT. �N FOFt GONSTRUC . ION PERMIT <br /> CITY OF EVERETT•BUILDItJG DIVISION <br /> 3200 CEDAR STREET•EVEAETT,WA 982Q1 •259•BB10 <br /> fl DEMOLITION fl COMBINATION fl BUILDING I� MECHANICAL fl PLUM8ING fl SIGN <br /> PROJECT ADDRESS � <br /> u <br /> OMIIIER MNLADDilE55 �I7Y ZIP PIqNE <br /> �e.�n•i s �'..�se,� 7/,� /is�'a.,� S E ��•S�wv1 9d'ZS�— 33Y-367'� <br /> TEN�NT /� MNL�ODRE55 CITY 21P PHONE � <br /> ��iuyS ( n r�5av <br /> A{ICIIITEGTOi1pE51GNER 'MIIA')ORE55 �Itt IIP PNONE � <br /> T,�r_rpssm� (�', .rl'�,.J , .�Zvrd-G'.I�'1, C;,,,.�sf yf�er .?c2-91�.•�v <br /> 'GENER CONTO�CTOR 5 �qIY ZIP PIqNE STATELICENSE� <br /> ��;r �'n�lsaN 7/� //5� u�X SF. �� �'sbu� 9�� 33Y-36�7 �����JiccISY1�t1 <br /> MECHMlICQCONTR�CTOR MNlAU011E55 GTY ZI7 PHpNE ST�TELICENSE� <br /> PIUMBINOCONTR�CiOR MAILAOORESS CIiY 21P PIqNE �7 SUTELICENSE� <br /> �^+ .�' / U P a S.�'�i I/ <br /> CONIMCT PRIGE Or M�pM <br /> ���� p�yj HEATING SYSTEM: 9tGAS fl ELECTRIC fl <br /> OESCPoBE RAN SOU�pEFO0TA0E VED Y• •� ONi�CTPER50H FIqNENO. <br /> ��� ��.- • �� �`j ._,j • <br /> aM � ��_ /,- � I HEREBY CERTIFY THAT I HAVE READ. ANO EXAMINED THIS <br /> s¢o us¢oa euappa APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � . PROVISIONS OF LAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � ���oes�cm,cr/non ot p PE�tt/�(S,IqW�N,,E,E,IOW OR�TT�CH TWO COFIES� p�pT. THE OHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior��t_aiocicJ.0.�1MJ1oF� � AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �,�k y�.2 �-v n - 1� 3 PERFORMANCE OF CONSTRUCT ON.TH T�I M AStTHORI ED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> r APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> v�wc�r�x i o.wuMeen CPNTRACTORS LAW 18.27 RCW AND 298200 WAC. <br /> - z - v - <br /> TRUC LO�N ESS.TElEP110NE MIMBER X _� � � � <br /> � (,� SION�TURE O� <br /> qTY BVSME55 LICENSE NO. <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlIfTUNE OR ITEM NO. TYPE OF EQUIPMENT FEE <br /> WATERClOSET�TO1LEn � NC—NHNDLOUNfTS—H.P. ' <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> HOWER � UNIiHEATERS—B.T.U. M ' <br /> K HEN SINK 6 DISP ; CLOTHES DRYERS � <br /> DIS ASHER � NTIUTION FAN � <br /> IAUND TRAV ; qA E HOO� ; <br /> CLOT}iES SHER � WATE HEATER � <br /> URINAL ' WOOD VE ' <br /> DRINKINO FOU ; METAL FIR CE(WOOD BURNIN6) i <br /> FLOOF ORA � FIREP I RT(WOOD BURNINO) � <br /> BACKFL PREVENTER ; 6AS EPLACE � <br /> SINK ERVICE—BAR,ETC. � RAN�E � <br /> ' 6115 PIPINO ' <br /> i EXHAUSTFAN � <br /> i � <br /> � � <br /> SUB TOTAL S ' SUB T TAL S ' <br /> PERMIT E � PERMIT f � <br /> TOTAL FEE S � TOTAI.FEE S ' <br /> FOFi OFFICE USE ONIY: - �� <br /> Fqp�TSETPACI( PEMSETMCN SIDESETBACI( Pl�NC11ECNNUMBER FEE n� AECEIPTNO. <br /> f� <br /> useia+e IOT�RE V�CANiSITE FEE VALUATION FEE <br /> ��3 f1YE5 fl NO BIIIlf11NC O �/ � i G�� <br /> UEIGIIT ll 7�� NO OF OWELLINp 512E OF BLOORI � <br /> .�G' UNIT$ / D � �] PLIIMBIN6 i <br /> O �) I <br /> Oq�PANCY IqO�S�MfS OCCUPANTLO�D BISEMENT MECN�NIG�L � <br /> _ ,N A �,.ES f.�NO , <br /> FIRE�L�AM qEOD RF.�SON �DDITION�L Pt�N CHF.' ' � <br /> ,, IIl i <br /> �v V OfNER � <br /> FIRE SVIiiN1(LER REO'D REASpN — � <br /> N� ST�I E BUIIDING SIttICH�ROE i!J"1 <br /> �JC ' <br /> TYPE �f,pNSL PL�NSA VEOBV CITY OF EVERETT PUBI.If,WORNS - � <br /> � ^ / n LOCALSALES <br /> � � o�te j- I -7 � TAX CODE IS 3105 TOTAL � Irp <br />