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� <br /> APPLICATIO.i FOR CONSTRUCT�JN PERMIT <br /> CITY OF EVERETT•BUILOING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 96201 •259•8810 <br /> �DEMOLITiON p COMBINATION O UILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: � �� k ,)� <br /> � <br /> OWNER �II�DDRES CITY SIP PIpNE <br /> � � /'�ti <br /> TEN�NT uAILAUd1F. 5 GIIY 11P �IIpNE <br /> �RCHIT[CT OR DESIGNER M1Il�OOqE55 CITY JIP PNONE <br /> ��'� �i' v.-,. s�ns'� ����' 300 7� ��fig� /�t��� (� G✓� %�?z <br /> w. ... <br /> .+� wnip�LT0i1 Mu��ODRE55 CIIY )IP PI10NE SfMElKENSE• <br /> MECNANICAICONTReCiqi M�II AUpiE55 f.ltt pP PIIONE AT�iE LICENSE r <br /> %UMBINGCONTR�TOR M�IlA0DRE55 Litt jIP PIIpNE STATELICENSE� <br /> � <br /> CONTRA�T PqICE OF MpRN <br /> HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> OESCRIlE WIMK AND Sq1ARE FOOTAOE INVOIVED GONTAGT FE1150NN/0 PNpNE/p — <br /> w,_, G�..�. 5� o a , ? <br /> I HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED THIS <br /> viwroseo u5e or eu�c�Ho APPLICATION AND KNOW THE SAME TO BE TRUE AND COflRECT ALl <br /> PROVISIONS OF UWS AND ORDINANCES GOYERNING THIS TYPE OF <br /> ����K�PT�NOFP�IOPERTMI�BEtOWORATTIILNTWpCOPIES� �'�'ORK WILL BE COMPlIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE �RANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINd CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOqK FOR WHICH <br /> APPLICATION IS MAOE AND 1 COMPLY WITH THE STATF. <br /> wwcEl T�x t.o.ruueea CONTRACTORS LAW iB27 RCW AND 296200 WAC. <br /> CONSTMILTIOHIO�HlENOER,�Oq1E55.fElEP1qNEM14EER x_ LU.�^ �i/-" �% <br /> SIGNAIURE OATE <br /> LYTY BUSINESS IICENSC NU <br /> PLUMBIN(i MECHANICAL <br /> MD• TYPE�OF FlIfTURE OR ITEM FEE NO. TYPE OF EpU1pMENT FEE <br /> WATER CLOSET(TOILEn � IVC—NHNpI,G UNfTS � <br /> BATHTUB ' FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIH) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRVERS ; <br /> D�SHWASHER � RANGE HOOD , <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CIOTHESWASI!ER � WOODSTOVE , <br /> URINAL � MEfAL FIFiEPLACE(WOOD BURNING) � <br /> DRINKINCa FOUNTAIN ; FIREPLACE INSEFiT(W0p0 BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS pIPING , <br /> ' EXHAUST FAN � <br /> � <br /> � <br /> � � <br /> � � <br /> � <br /> � , <br /> SUB TOTAL S � SUB TOTAL f <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE f � TOTAL FEE f � <br /> FOR OFFlCE USE ONLV: <br /> FRpMTSETb�CK NEAqSF.TB�CK SIDESETB�CN P�uILUECRNU�BF11 PEF HEf.E1PiNO <br /> � " S <br /> USEIONE ioT�n¢n V��ANISIIE FEES VAIUATION FEE <br /> ❑YE$ ❑ NO <br /> OIIIIDINf � <br /> � <br /> MEI6NTUTAGTION NO OF OWELLIh� SIIE Of BIDGR.I � <br /> UNIfS <br /> PlUN01NG � I <br /> r <br /> � <br /> OCCVPANCY �p ptSlMifS OCLUVANTl0�0 BA$E1,�Nf �— <br /> GRWP MECMeHIL�I <br /> OYES ❑Hp � - <br /> FIIiESPRINKlER11E0'D RE�SON �I)WIIpN�L�Y�NC�IfCN � <br /> Q111E11 <br /> FIREµMMpEO'0 RE�50N ` --' <br /> STMEOU40w65unUu06E � , <br /> rrvEotr,or�sr � r�nnsenrr+oveoar CITY OF EVERE7T runur.wnnKs _ � <br /> LOCALSALES --�— <br /> o�re TAX CODE IS�105 TOTAL , <br />