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� <br /> � <br /> APPLICATIOtr FOR CONSTRUCTI��N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT,WA 98201 • (425)257-8610 <br /> ❑ DEMOLITION ❑ COMBINATIOLN /� ❑ BUILDING ❑ MECHANICAL ❑ PIUMBING ❑ SION <br /> PROJECTADDRESS:�Iv �p�Ch �.//rd2 � Ede%�/�•� °1'Sfo2o3 <br /> r�-�. /�'�e►++or.al �ow+vt+uy'rv � htai� r'Inu✓cl1 y,2S-3S3- �2a� <br /> OWNER Msq11DDNE55 � CiTY I�P PNONE <br />._�,.. <br /> 1EN�Nf MMl�b0AE55 GTY lIP FMONE <br />'�' � <br />••'��� 11RCHrtfCTOR�ES�G��Ef1 M�II�ObPE55 GIIV 7�P �NONF <br />�r-� �U�rK Or�Pe✓' Coti'fV'�+c �h� �i.�z✓el� �✓�. ��z�� zsa-9�z� �Rkoc�o�.zJ"M <br /> GF.NEII�L CONip�GTOfI M�II�DDRE55 Cliv 7iP P�IfJVE SGfE LICCNSE� <br /> MF.CH�NIC�L LONTR�CiOp M�R�ODNE55 Cltt 21P PIIONf STJ�TE LILENSE� <br /> PLUMBING�ON�R�f,TOR M�IL�OORESS Cltt 2�P PHONE ST�TFI.IGENSE� <br /> a �.� <br /> CONfR�CT VNICE OF WpiK MEATING SYSTEM: ❑GAS ❑ ELECTRIC � <br /> CRISE V/ORK�ND SOU{��p E FOOT�6E WVOLVED � CpNTACt YERSON 11N0 f'110�1F.HO <br /> �Q YOIi I IV SCQ d�IrS. <br /> Ir0 �/MQIC� �1 /.✓��{e A11 �` �Olq <br /> /C'� /N�IN�P � �A�1 /t? 5 I HEREBY LERTIFY THAT I HAVE READ AND EXAMINEO Th11S <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> - PROPOSED USE OF BUILDINO pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �. WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OA <br />�n�� IEG�LDESCRIPTIONOfPROPERTY151qMMBELOWOA�7'7�CH1W000PIE51 rypT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 6WE <br /> iot e�ocK ov AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> . OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �� OWNEH OF THIS PROPERTY TO PERFORM TME WORK FOR WHICH <br /> � - APPLICATION IS MADE AND 1 COMPLY WITH THE SUTE <br /> r,wcEl i�x�o.r�uweeA ,_ n CONTRACTORS UW 1827 FCW AND 296200 WAC. <br /> �V 14 �g�D O�c D O oe' /D—i5-�7 <br /> CONSTHlIC11p/IO�N IENUER.�ODAE55.TELfPMONE MUYBfH r <br /> S�GNpURE D�tE <br /> �ITY BUSNESS LiCENSC NO <br />� PLUMBIN6 MECHANICAL �E <br /> Np. ,TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EWIPMENT <br /> WATER CLOSET(TOILE� � NC—MINDL6 UNRS ' <br /> BFTHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIi�) � HEAT PUMP ' <br /> SHOWER ' UNIT HEATERS <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CIOTHES WASHER � WOODSTOVE ' <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIHEPLACE ' <br /> � GASRANGE � <br /> BACKFLOW PREVENTERS � <br /> SINK (SE�NICE—BAF.ETC.) GAS PIPING <br /> � EXHAUSTFAN <br /> � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL S ; SUB TOTAI S 1 <br /> PERMIT S � PERMIT S <br /> ?OTALFEE S ' TOTAIFEE S <br /> FOR OFFICE USE ONLY: <br /> fRONTVTP�Gk AF�RSFIB�LK SIOESEfB�L1t <br /> P�ANCUECNHUMNfR fEF �Ff.FIPTNO <br /> !Lc7�� <br /> FEFS VALUATION FEE <br /> USE 20Nf lOi�PEA VI�C�NI SITE -�— <br /> �YES 0 �1 BU1l01Nf. �-7� � 7 �!�� �vv <br /> i <br /> ��EIGNI VMITATION NO D�UWEIUNG SISE O�BIDGRI � <br /> UN�IS FIUMN�N6 <br /> - —T <br /> 1 <br /> OCGUP��.f.Y IK/M SIPn:fS Of.f.UP�NI 10�0 B�SFMENI MPCIISMGI � _ <br /> Gf10UP ❑YES O HO � <br /> 1 <br /> �Dd IION�I.�l AN C��CCR � <br /> FIPE 5('P�N1tLER FEO'D �F�SON � <br /> O���En <br /> fIPE AIARM REO'0 RF�Sqv -- / � C ;� <br /> SI�IFIIUIlO%NGSUOCIUfIGE ' _� l,� � <br /> �rrEOrr,O�ist rinNs rnovennr CRYOFEVERETT runi�cwon.s ___;__ <br /> �{+� LOCAL SALES ' — -� � J ' <br /> ��� �p _ �j _ F TAX CODE IS 3105 TOTAL __ �/' <br />