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-� <br /> APPLICATI�rN FOR CONSTRUC'� ION PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-BB10 <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUINBING ❑ SIGN <br /> PROJECT ADDRESS: <br /> OMI�/L11��� 1/ MN�AWRE55 / �Itt� �Z�IP� rNpNE <br /> �f(J J`� f�i�/I'>Oi v� z�IJ() L /� fI l//�/'J /% (�!� - C�" 11�ZCJ� �5�'�y <br /> IEN�NT MNL�DdiE55 GITY ZIF PHONE `� <br /> l�LliJ'I� <br /> •RCMiECT OR DESiGNER MM AODRESS GIiY 71P PHONE <br /> /ll/�l�c G1I/l/Zi2 f�c'A%E5� Z OU /G L Q ,�i-:I r �� �c�/%lc G���%/�D�/�� <br /> �—� � � /�/ <br /> MECNAqIClLLCONTRACTOR MAIIADpiESS Cltt ZIP PIIONE STRELICENSE� <br /> 2�z-��Od <br /> PLUMBINGCONTRA�TOR M�IL�DdiE55 Cltt IIP P1qNE ST�TEUCENSE� <br /> CONTMCT VipCE OF WORN <br /> — HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OESCqBE WORK�ND SOU�RE f00TMsE INVOWED LONT�CT PERSON ANO PNONE NO �/ <br /> (/6V� <br /> � � ' � 1i�2` d <br /> I HEREBV CERTIFY THAT I HAVE READ AND [XAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSED USE OF BUILdNO PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �es�uoesca�ar�a+avnorEair�s�awr+ee�owon�rt�cHTwocoaies� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PR TV TO THE WORK FOR WHICH <br /> APPLICATION I ADE PLY WITH THE STATE <br /> p�cE�T�utip.rxlr.�Ep � CONTRACTO LAW R 6 ODWAC. <br /> CONSTpUGT10N LOIW LENDER.�OIX1E55.TELEPlqNE MIMBEP x � <br /> SIGNATURE D�T <br /> CITY BUSINE55 LICENSE NO <br /> PLUMBINO MECXANICAI <br /> NO. TVPE OF Fl%TURE Oli ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—A/HNDL6 UNfTS � <br /> BATHTUB ; FOflCEDAIRSYSTEMS ; <br /> L /ATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 8 OISP � CLOTHES DRVERS � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; ' WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' MEfAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT�WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> IXHAUST FAN ' <br /> � <br /> i <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERM.IT S i PERMIT f ' <br /> TOTALFEE f ' TOTALFEE E ' <br /> FOR OFFICE USE ONLY: <br /> fRONiSETRACN FE�RSETB.�CN SIDESE76�CIt �l�NC11FCKNUMPER fEF �Ff.F.IPfNO <br /> � � <br /> use zoNe l01�PEA VACANT SIIE FEES VAIUATION FEE <br /> T <br /> ❑VES ❑ NO B1111DINC � <br /> NEIGNi LIMITATION NO OF DWEIUNG 512E OF BLIX'✓fl i <br /> UNIt$ p�pyplNG <br /> � <br /> OCCUPANCY Iq(1f Sipu[5 OLLUPANf LO�D BASEMENT � <br /> G��p MECII�NICQ � <br /> OYES ❑NO <br /> FIflESPflINKLERREO'0 �F�SON �DDIIION�LPUNGnF.GK i <br /> i <br /> 0111E0 <br /> FIREMMMREO'D RE��ON <br /> SIAIE BUIlUIN651NC1U116E • <br /> trreoFr.or+sr vinNserrnov¢nev CITYOFEVERETT rueur.wOnn•. <br /> LOCAL SALES — —J— <br /> �,❑E TAX CODE IS 3105 ToiAL I <br />