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CITY OF EVERETT • BUILDING DIVISION �� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />O DEMOUTION �(. D COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS': �,a8�o ����Pj-- 1 ��p��'e�- . (,�� q8ZC7 I <br />b�t,l u1rlu- Ke <br />._.__ _._,..__..,.,,,, „��. nr P110NE <br />AqLPoT[CT OR OESIGNER MAII �DURE55 LIiY ]u' PIIONF <br />GENEMLCONTR�CTdi M�IL�OOOESS GIIY )iP PiIONE iflqEIICENSE� <br />MECHMlICQCONTRACTOF MNLAOpqE55 (:Itt 7iP PnONE ST�7EUCENSE� <br />� tP5 <br />PIUMlMGCONTRACTOR M�IIADOPE55 Clfv IIP p11pNE STATELICENSE� <br />Mq Sq1�RE FOOTA6E INVpWED <br />tEwloEScwPTIR10F VIqPERiY 15NOWN SELOW ORATfACM iWp COPIE5) <br />ioT e�ocK oc <br />PANCEL PUl I.D. MIMBER <br />GONSiNUCTp/ LWH LENDER.I10D11ESS. TELEPIqNE NUMBER <br />PLUMBIIW <br />NO. TYPE OF flXTURE OR ITEM FEE <br />WATER CIOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCNEN SINK 8 DISP <br />DISHWASHEH <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FHONT SETB�LI( pEAq SETBACk SiDE SETB�CN <br />USE20NE <br />NE16NT UMITATION <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />LONUC.i PC�SON �ND PHpNE NO <br />I HEREDY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH NhiETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOH WHICH <br />APPLICATION IS MADE AND ! COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW ANG 296.200 WAC. <br />� �Q u -�- a.�iklt� U - %cPA �f - f ( - `t 7 <br />SK:N�iURE DATE <br />CITV BUSINE55l10EN5E NO <br />MECHANICAI <br />NO. TYPE OF EOUIpMFJ1T FEE <br />rvli — /VnnuL1 <br />FORCED AIR S' <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYI <br />RANGEHOOD <br />WATER HEATER <br />WOO� STOVE <br />METAL FIREPIA <br />FIREPLACE INSI <br />GAS FIREPLACE <br />GASRANGE <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE S <br />PUNCUECNNuu.pLR � FEF I RECEIPTNO <br />lOi �RE� vecu�t SiTe FEES <br />OVES O MO BUILOM6 <br />NOOFOWELUNO SIIEOFBLOGRI <br />UNI7$ P�UM(11N6 <br />OCCUP�NT LO�O BASEMENT MECN�NIf,�I <br />❑YES ❑ NO <br />REASON �OWIIONAI. PI �N C�RCN <br />OIBEO <br />AE�CpN <br />ST�iE IIIIII�INC.SUfIC11Ap0E <br />PL�NSAPPROVEDBY CITYOFEVERE7T �Ilplif.Wpf1NC <br />LOCAL SALES - <br />o�TE TAX COUE IS 3105 TOTAL <br />