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APPLICATif"�1 FOR CONSTRUCT'"�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 88201 •259-8810 <br /> p DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS:��� /Al P <br /> 1 /pN.L�S� (',A,4,� a 37 C' G�R.9.�.{ SC. �`� Fwr2�iL Gw+'� 4aT.i 't 79 �i J- 7 <br /> �MMER MNLMpIF.55 Lltt <br /> ZIP PIIpNE <br /> TEIUNi NN11100i1E55 f.ITY 71P PI�ONE <br /> 'YhMDKffJV N <br /> MCM�CC DESIGN^ER / /MIIADURE55 LITY 711` PMONF <br /> �.l�Pr n.i1 l!�/C('e n. <br /> CIENEMICONTMGTOR MNlMp1E55 f.IIY - )iP PiIONE $f�IEIICENSE• <br /> Tr C ��.�- <br /> MEGHANC�LGONTR�CT MMlA0pRE55 GIfV IIP PNONE STATELICENSE� <br /> MUIMNGCONTH�CTOR 4YL/�DONE$5 CIIY TIP PIqNE ST�TELICCNSE• <br /> GONiMCT Pp�pF WpqK <br /> ;i ;y'� :� HEATING SYSTEM: O GAS O ELECTRIC ❑ <br /> UESC�MSE WOIUf�!q SqMRE F00T/�OE MIVOWED LONi�CT VERSON Mq PH011F.NO <br /> rj,(/) ilG� e��._, <br /> I HEREBY CERTIFY TNAT I HAVE READ AhD EI(AMINED THIS <br /> waroseo use a eu�pra APPLICATION AND KNpW THE SAME TO BE TRUt AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> _ WORK WILL BE COMPLIED 4VITH WHETHER SP?CIFIIcO NEREIN OR <br /> ieakoescnwrar�awarEmr�s�awnanowon�i;��cnnvocov�s� rypT. THE GRANTING OF A PERM�T DOES N�ll PRESUME TO GIVE <br /> io� xacn pc AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTNER STATE OR LOCAL LAW RE�ULATINO COYSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOfi WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE $TATE <br /> MRCEL TM I.D.MILNER CANTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSiRUCTqN IO.W LENOER.ADORESS.IELEP110NE MMIIEP �1/ � �dn JCr.'A <br /> 5��� �AlE <br /> CIIY BUSINESS IICENSC NO <br /> K�� YECMANICAL <br /> NO. TYPE OF FlIfi1ME OR ITEM FEE NO. TYPE pF EplrypL�ENT FEE <br /> WATER Cl OSET(TOILET) � NC—NHNOLQ UNfTS � <br /> �TMT� ; FORCED AIR SYSTEMS ' <br /> LAVATORV(WASH BASIN) � HEAT PUMP , <br /> SHOWER ^ � UNITHEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS � <br /> D�SMAIASHER � RANGE H000 � <br /> LAUNDRV TRAV � WATER HFATER ' <br /> CLOTNES WASHER � WOOD STOVE � <br /> UR�N�I. ' MEfAL FIREPLACE(VYOOD BURNING) � <br /> DRINKIN6 FOUNTAIN i FIREPLACE INSERT(YYOOD BUHNING) i <br /> FLOOR DRAIN � (3AS FIREPIACE � <br /> BACKFLOW PHEVE:JTERS ; •'�/ GAS RANGE ; <br /> SINN(SERVICE—BAR.ETC.) /6 GAS PIPING � � <br /> V I IXHAUST FAN <br /> � � <br /> � , <br /> � " , <br /> � <br /> � <br /> SUB TOTAL S ' SUB TOTAL f ; <br /> PERMIT f � PERMIT f � <br /> TOTAL FEE S � TOTAL FEE f � <br /> FOR OFFICE USE ONLY: <br /> i110NT5ETRl�GR REM^ETMCN SIOESE1PUK 1`I�NCUECKNUMfllfl tp[ OFf.fIPTNU <br /> uSETor� iote�.En v�ceNisn[ � FEES VALUATION FEE <br /> ❑YES ❑ NL --- T <br /> Illlll�!Nf. i <br /> 11Eq11I IIWUTION NO Of OWELLIN6 SISE W Bl[%'i/11 ------ ----- <br /> UNITC <br /> P1111ApIN0 � <br /> O('rpC1U�ANC� ND(s SIMES OLCl1P�Ni IO�D BASEI.IENI I � i <br /> �MECIV.IIIGI <br /> i <br /> ❑YC$ U NO _��_ _.�____ __ <br /> I <br /> FIRESPRiNKLEFPEO'0 REASON �DDIIIpNM.Pt�NC�IfGR � <br /> �—� <br /> O711ER <br /> FIRENMMPEO'D REASpN <br /> SUIE OUI':.:1C SIIRCIUOOE <br /> i <br /> TY{`EOLf,pMSI PL�NS�PPROVEfIBY CITYOfEVEREIT �IIfl11f.WO11N5 <br /> LOCAISALES ------- — — -- -------'— <br /> oeTE TAX CODE IS 7105 T0�I1L <br />