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APPLICATI4.J FOR COIdSTRUCT. .lN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION �.J <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-eB10 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL LUMBING ❑ SIGN <br /> PROJ�FCT ADDR � _lG Jy D�1 f �U <br /> \n S� l�UP_ �AX/ER <br /> IER IMR E55 CI�Y ZIP PNONE <br /> �DJ/��y D�,�,�Av t��,csT/ <br /> iEN�NT MNL�OONE55 GITY IIP PNONE <br /> �RLMTECTOROESIGNER MAlL�001iE55 CITY llf' PNONE <br /> 6ENEPMCONTMCTOR MNLADD{IE55 CIIV 71P PnONE 5(dEUCFNS'c� <br /> MECMIIMGLLCONTR�CTOR MA1lADdiE55 CIiY Zm PIIONE STATEIICENSE� <br /> �I�IVL / LOT �IIAM L1�.yY 5�� /1� U !IP PHONE �/Y` STATELICEMS�IAi1/ � �(YFr <br /> V U V <br /> CONTR�T VRIf,E OF Y/diK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCMSE NVRK ANO SOUARE FOOT/iGE INVOWED CONT�LT P[RSON AND PlIONE NO <br /> �a G -cc-� <br /> I HEREBY CERTIFY THAT I ';AVE READ AND E%AMINED THIS <br /> APPLICATION AND KNdW THE 5AME TO BE TRUE AND CORRECT ALL <br /> vnoroseouse a euiarxi PROVISIONS OF LAWS AND�JRDINANCES GOVERNING THIS?YPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> t�°K°Esa°°T�°"°FP"or�pTM(s�°w"°Ei°Wa+"TT'�cMTw��°P'Es) NOT. THE 6RANTIN6 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> �oT e�acic a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> ' OTHEq STATE OR LOCAL LAW RE6UUTIN6 CONSTRUCTION OH THE <br /> PERFORMANCE OF CANSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HI5 PROPERri TO PERFORM THE WORK FOR WHICH <br /> APPLICATIGN IS MADE AND I COMPLV WITH THE STATE <br /> MRCEL TNf I.D.MDMER CONTRACTORS LAW 18.27 RCW AND 196200 WAC. <br /> CONSI/NlCiION IOAI LENDER.�OORESS.IELER1p1E MIMBER X � //—CJ� <br /> I <br /> SICN�TVRE D�TE <br /> CITY BUSINESS IICENSE NO <br /> PLUAIBING MECHANICAI <br /> N0. TYPE OF flKTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—AMNDL6 UNRS � <br /> 9ATHTU9 ; FORCEDAIASYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINN 6 UISP ; CIOTHES DRVERS ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HFATER ; <br /> CLOTHES WASHER � WOpD STOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ; <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE —T— <br /> BACKFLOW PR[VENTERS ; GASRANGE ; <br /> SINK�SERVICE—BAR,ETC.) � GAS PIPING � <br /> ; IXHAUST FAN ' <br /> � <br /> � � <br /> 1 � T <br /> SUB TOTAL S ; SUB TOTAL S ; <br /> PERMIT S � PERMIT S i <br /> TOTALFEE S ' TOTAIFEE S. ' <br /> FOR OFFICE USE ONLY: <br /> FRdlT SEfB11CK RE�R SFTB�CK SIDE SETB�CN PIAN CIIEGI(NUMIIEf1 ('EF �CEIPT NO <br /> rS�c <br /> useior� lOTl1RE� V�C1Wi5t1E FEES VAlUAT10N FEE <br /> _ ❑YES ❑ NO BUIL�ING � <br /> MEIONT 1141TAtION NO OF DWELIING SILE OF B106R1 � <br /> UNIfS Ptp1A01NG <br /> � <br /> a�ANCY Iq(%5�(MUFS O:CUPANTLO�D 9�SEMCNT MECIUNICM � <br /> ❑YF$ ❑NO <br /> FlRESPRINKLERREO'D RE�SON �DDIIION�LI'UNCIIGCN � <br /> � _ <br /> on�En � <br /> FIREAUAMflEO'D AE�cpN <br /> $TAIC 8111101N1i SU(ICIU110C � <br /> Trveovr,ovst v�nNServnovEoev CITYOFEVEREII' ��iAi�r.wonKs <br /> LOCAL SALES — --'— <br /> o�TE TAX CODE IS 3105 70TAL I <br />