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APRLICATIC� FOR CONSTRUC7 �N PERMIT <br /> CITY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8610 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ pLUMBING ❑ SIGN <br /> PROJECT ADDRESS: �� (� �i�-�,�� ��� �_(� �i����,f�� <br /> OVMER MMl�00RE55 C,/ltt �.,�/ 711� PIIONE <br /> �7�"i"���/�� �� �� ���'1���� /I(L`u.U������ "l i.� � ) �t�i � <br /> lEN/J!T • IAnILADU11f55 � � CIIY !11` PIIONE ' <br /> V � <br /> �RCNITECTOROESIGNEe MMI�OOnE55��' ' GtY 71P � P�IIO/yE <br /> �(�/ 7 �� <br /> 6E ERAICONiR�GT011 M�I�eDIlI1E55 f.I1Y � •Ii• �IbNC ctATEIICFNSE• <br /> � <br /> / �,t� (,��,A T%`��--,� �-{��!? I 1�� 7 h(�i �t���' !)���.�f��,- �(i%Gc' �;� /.d��/��,/�.� <br /> MECNANICALC TP�CTO MAll�00RE55 cirv " rm ru�� STUELILENSE� <br /> (/� l�- —_'"' "'__.' <br /> PLUIMINGLONTP�CTpI IANLAtlORE55' ' � " '� `� CItY 1��' PI10NE SiATEUCENSE� <br /> .� . <br /> � ' ��i <br /> CONTMCT PPICE OF YIORN - . <br /> � S�� � HEATING SYSTEM: GAS O EIECTRIC ❑ <br /> OESCMSEYIORK�NOSOU�REFOOIAGEINVOLVED CONVf.IPO15pNANpP11pNEN0 � <br /> � <br /> �,y�l<f �;� � <br /> L�r ,. �;- /�li � � �� � ---- zr�i.- ���1'i-1 <br /> I HEF7EOY CERTIFY THAT I HAVE READ AND EXAMINED TI'!S <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br /> raoroseo use or e�n�on+a PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LECALUESCRIPTIONOFVROPERTYI���BELOwpi�TTALNTWOCO%ES� NOT. Tl�E ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr e�ocK or AUiI!UHITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHcR STATE OR LOCAI LAW REGUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP�RTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS�M"ADE�AND �I . COMPLY WITH THE STATE <br /> PIACEL TNI I.D.MIM!!R CONTRACTORS.t�AW,1B27�fiCW AND�296200 YlAC. <br /> . � ' � � � � /� �� �. i � � � / � �'-- <br /> CONSTRIICTlp1 LOAN IENDER.ADdiES .TEIE E NUMBEII x_ � / / / <br /> SlfiNqllRE �� 0�7[ <br /> CI1Y IIUSINF.SS IICF.NSE NO <br /> PLUMBIN(i MECIIANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATEH CLOSET(TOILET) � A/C—AMNDL4 UNfTS � <br /> BATHTUB ; FOf10EDAIRSYSTEMS ' <br /> UVATORY(WASH BASIN) � IiEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS i <br /> DISHWASHER � RANGE HOOD � <br /> UUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> UFlINAL ' MEfAI.FIREPLACE(YVOOD BURNING) ' <br /> DFINKIN6 FOUNTAIN i FIREPLACE INSERT NYOOD BURNING) i <br /> fLOOR DRAIN � GAS�IREPUICE � <br /> BACKFLOW PREVENTERS ; GAS MNGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING � <br /> E%F!AUST FAN ' <br /> i � <br /> � <br /> � � <br /> SUB TOTAI f ; SUB TOTAL S ; <br /> PERMIT S � PERMIT f � <br /> TOTALFEE S ' TOTALFEE S ' • <br /> FOR OFFICE USE ONLY: <br /> FIIOHTSETBALN PEAq5F1B�CR SI�ESETB�CN rin��aiteKeaiunrn � IEF �Ef,EIPTHO <br /> _C'� <�OS <br /> USEZONE IOTARE� v�cenrsr[ FEES VALUATION FEE <br /> ❑YES ❑NO p��qlLNf � <br /> i <br /> HEK�NT UMITATION NO Of UWEtLIHG 512E OF BIOGR I ---'- <br /> VNIIG I�IIIMf11N(i <br /> �_.�___._ —� <br /> OCCUPNILY Iq Oi51(MtlFS OLCUP�NtLO�D B�SEMENT � <br /> Opal� MEI:IIENIf.M � <br /> ❑YES ❑ n0 ---- i — <br /> FIPESPNNKLEPREO'D �FASO'1 AODIIION�I P��HGIICN � <br /> i <br /> omen � <br /> FIREAURMflEO'� RE�ipN 1 <br /> Slnl{'pllll W�IG 5pf11llnflCC <br /> i <br /> _—'_ ___' �_ <br /> tvvEotr,pNST v�nNserrnovenov CITYOFEVERETT rumir.wrnv.�• <br /> LOCAL SALES --- --- — — --'— <br /> o�iE TAX CODE IS 3105 ToiAl I <br />