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APPLICATIG_J FOR CONSTRUCT.JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 ��" <br /> ❑ DEMOUTION � COMBINATION ❑//�B�UI DIN(i O MECHANICAL ❑ PLUMBINd ❑ SION <br /> PROJECT ADDRESS: <� , ) I �� C..f,L�5 <br /> �CLrrcl 77�1/ S]2��'2��{�/ZU� � S�tuX,�� =f.�l.`I�Z P ��Z ��7r�' <br /> EN�NT �ES� GIIY 11P PNONE <br /> MCIMTECTOROESIONEN Mlull100NE55 Cltt Im P110NE <br /> J ��J T`C'/`�J/' ��/� �/J r�lL•Gf' / I! ��L�/G`i�� III`- �� �P' 1 ��) �� $I11�1 (is�T�..J/��l <br /> 7� <br /> MEd1ANIGflCONiR�CTq1 MAq�DORE55 CITY ZIP PIIONE ST�TEIICENSE� <br /> PlU1.MINOCONTNACTOR MNLIIOOilE55 Cltt ZIP PNONE STATELICENSE� <br /> ��T��� CG O �v HEATING SYSTEM: ❑GAS �ELECTRIC O <br /> oexaeE ua souu�rooi�wvaveo CONT�CT PERSON�ND PIqNE NO <br /> \ d � LG <br /> ' � 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � ��� PROVISIONS OF UWS AND ORDINANCES GOVERNINCi THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �oKqEscqv�qnarrov¢an seiowaa¢ N 6PIE5 NpT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> im G o� ���� � CC d !��/1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR IOCAL LAW REOULATIN(3 CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOfl WHICH <br /> APP N IS MAD AND 1 COMPLV WITH THE STATE <br /> ►�ncEtT�a��.o.M�n NTRACT LAW1B. RCWAN0298.200WAC. <br /> Wwlq cnprL Er1.AooneSs.releRaNEMMlEa G� LL / `/K/ <br /> SION�TIIHE �. <br /> pTYlUSINESS LICENSE ND <br /> p�{��q MECHANICAL <br /> IW. TYPE OF flIRURE OR ITEM FEE NO. TYPE OF EGUIPIAENT FEE <br /> WATER CLOSET(TOILEn ' A/C—AIFNJdA UNfTS ' <br /> gATHT1IB ' FORCED AIR SYSTEMS ; <br /> LAVATORY(WASM BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS ' <br /> KRCHEN SINK 8 DISP � CLOTHES DRVERS � <br /> dSHWASHEH � RIWOE HOOD ' <br /> uu+wrv r�ur � WATER HEATER � <br /> CIOTHES WASFiER � WOOD STOVE � <br /> �pp� � MEfAL FIREPLACE pN00D BURNING) ' <br /> DRINKINO FOIMiTAIN � FIREPLACE INSEfiT pNOOD BURNINO) � <br /> FLppp pqNN � OAS FlREPLACE ' <br /> BACKFLOW PREVENTERS � GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GPS PIPING � <br /> � DQiAUSTFAN ' <br /> � <br /> i ' <br /> � ; <br /> � <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL f � <br /> PERMIT S � PERMIT f � <br /> TOTALFEE f ' 70TALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> F/IONTSETMCK AEMSETMCK SIDESET&�CK MIWCIIEGNNUMBER �EF ���f� <br /> � <br /> usE ia+e tot u�� v�cu+T yre FEES VAIUATON FEE <br /> 20 ' <br /> OrEs ❑� eumm¢ � ) � <br /> IIE16HTUMT�TION MOOFDWEWNO SIZEOFlLUCJf.I � <br /> UAIC pIUMBING � — <br /> pLCW�NLY Iq0�5i(wE5 OCCIMI1NtLWW BASEMENT MECNNIIGIL i <br /> OIIdR <br /> ❑YES ❑NO <br /> FlfiESPPoNIQENNEO'D NEASON ADOIi10N�lPlu1CNF.CM � <br /> i <br /> i <br /> OfHER i <br /> FIPEAWiMREO'D NE�CON ' <br /> � <br /> STA1E BUIIDINf.SUiiCN��16E <br /> TYPE OLl:OMST PL�NSAPPPOVEO BY CRY OF EVERETT MI911f.WORNS , <br /> LOCAL SALES —�— <br /> o�TE TAX CODE IS 3105 TOTAL <br />