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APPLICATIO' FOR CONSTRUCTI N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> . 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> ❑ DEIYIOLITION ❑ COMBINATION (�'BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: �(�� ;t� �''�i(L(��, l�le <br /> ONMER MNL�DdiE55 CITY 21P PHOHE <br /> I�iA��lGuu��n»kn,.� /Id,SGak� Ave i-'v��elF cv�-i- 98�i �Sa-5?3 / <br /> iE1UNT Mq11100i1E55 GTY IIP PIIONE <br /> ARLMTEGTp10E5NiNER I.W1110DRE55 CITY IIP PIqNE <br /> f3ENEMLCONTMLTOR MNL�DONE55 piY zll' PIIONE $GTELILENSE• <br /> MECH�NIGILCONTRACTpi MAIt 11Dd1E55 CITY bP PNONE STATE UCENSE� <br /> PIULlMMrCONTRACTOR M1Ul11WRE55 CITV IIP PlqHE STATELICENSE� <br /> CONTMCT i1MCE OF 1YORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OEBCINE M101rf AlOSW�RE FOO7MiE NlVOlVEO CONTACT PERSON ANU PIIp1E Np. <br /> U� <br /> I HEREBY CERTIFY THAT I HAVE READ AND El(AMINED THIS . <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CpRRECT A.!_L <br /> �����°ULpNO PROVISIONS OF UWS:UJD ORDINANCES GOVERNING THIS TYPE OF <br /> WOqK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEMl0E5f7WT10HOFPiqPERTY�SlqWNlELOWORATT�CNiMqCOPIES) NpT. THE (iRANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or xaa oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANl' <br /> OTHER STATE OR LOCAL LAW qEaULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICF: <br /> APPLICATION IS MA�E AND 1 COMPLY WITH THE STATE <br /> pµCEl T�x i,p.q r.� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �a 33� ov� �3 / , /� <br /> CON571MIC110N WWLENOEP.MdiESS.TELEP/10NENU1lEP XJ__f'1��./ v��'�`�"�''Y� ���/�/ f� <br /> SIGN�TURE ��T D�TE � <br /> dTY BU$INE$$LICENSE NO. <br /> K�� MECHANICAL <br /> NO. TYPE OF FlXiURE OR I1EM FEE NO. TYPE OF EQUIPMEqT FEE <br /> WATEH CLOSET(TOILEn � A/C—NHNpLO UNfTS � <br /> ��� ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> ��R ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORVERS ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> • CLOTHES WASHER � WOODSTOVE � <br /> URINAL � METAL FIREPIACE(WOOG BUANIN6) ' <br /> DRINKIN(i FWNTAIN ; FIREPLACE INSEtif(WOOD BURNING) � <br /> ROOR DRAIN � (iAS flREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ; <br /> SINK(SERVICE—BAR,E1 C.) � GAS PIPIN6 �— <br /> ' DCHAUST FAN ' <br /> i <br /> � i <br /> i � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S ; <br /> PERMIT S � PERMIT S � <br /> TOTAIFEE S � TOTALFEE S ' � <br /> FOR OFFICE USE ONLY: <br /> FRdIT$E19AC1( REAlISET&1LN SIDESETBIiLN PIANCIIEC1cNUGBEf1 FEF REf.EIPTNO <br /> ��� <br /> useza� L0T11REA v�cu�rare FEES VALUATION FEE <br /> ❑YES ❑� BUILDINC i <br /> � <br /> �roNruu�r�rror� raaowewna sizeaxoc✓ri , <br /> UNIfS PlUA181NG i <br /> � <br /> Q��ANC� NO Of SIOfw'Ei OCCUPMIT LO�D B�SEIAENT MELM�NICAI i <br /> � <br /> ❑YES ❑NO � <br /> FIRESPfUNKIERHEO'D RE�SON �OOIfION�L�LANCNCCK . i <br /> OTIIER � <br /> FINEMMMPEG'0 pE�SON <br /> STAtE BUIlDM6 SIIRCN�f10E ' <br /> i <br /> _' �— <br /> TYPEOif,ONST VUNSAPPROVEDBY CRYOFEVEREiT PIIBt1f.WOPRS � <br /> LOCAL SALES —�— <br /> o•TE TAX CODE IS 3105 TOTAL <br />