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APPLi�ATiC�I FOR CONS`�Ri1CT'�7N PERfJ11Y <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 90201 •259•BB10 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING ❑ MECHANICAL ❑ PLUMBINd ❑ SIGN <br /> PROJECT AODRESS: I��JZ E. ►�a2�r�� ✓/� I.J /,7�, <br /> E(�ESi r'�'lo�P�: io32. �. m�wNrs✓���J ,�,���; 9�3za� 2sr- is83 <br /> OYMiEP MNI�WRE55 CIIV 11P P110NE <br /> TEIUNI MqL�D0i1E55 f.11Y lIP PIIONE <br /> S�M� <br /> �RLHITEGT OR DESIGNER AI/Jl�DpiE55 C1tt 71P PIIONF <br /> SA�nc <br /> GENER�L GOl1tpACTp1 MNL,WORE55 CIIY )ip PIIONf. SGIE IICENSE• <br /> MECNANICGLCONiRACT(%1 MIULADq7E55 LITV Zm PIIONE STaEIICENSE� <br /> MUYBMMaCONTR�CTOR MMLAOONESS CItY j�p PHONE STATELICENSE• <br /> CONTMCT PR1LE OF WpiK � <br /> �2,30'O `� �j Z 9� NEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ NO/�E <br /> OESCpME WOHK�ND SOII�RE FOpTAGE WVOLVED CONT�CT PERSON�NO PNONF.NO <br /> W i TH FlC � E <br /> a z a�C� s39 <br /> S I ORG V� � (�AROC/.� I�OLS � HEREBY CERTIFY THAT I fiAVE READ AND EXAMINED THIS <br /> �,aroseo usE a suipra - APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> __ WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGKUESCPIPTIONOFPIqPERTY�51qWNpElpWpqlITTAG111WOCOPIES� NOT. THE GiiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi aiaac � � Z � � V I O1J T AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> TAI�c 37 OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE <br /> S V� � EAST NALF O L-. O F PLA 1 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> I1 (-� C OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> }$ T 3 C7� ' I �1 �Z..� DUO r �ZOB APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> wwc�i�i.o.Mw�a -- CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTIONLWNLENDER.App1ESS.TELER/ONENUMBER x__���� W . /� � Q�Di.�� �j — I Z—� � <br /> SIGN�TURE D�TE <br /> CITY BUSINE55 LICENSC NO <br /> �V�� MECHANICAL <br /> NO. TYPE OF FlIfTURE OR ITEM FEE NO. 7YPE OF ECUIPMENT FEE <br /> WATEH CLOSET(TOILEn � A/C-MiNDLG UNfTS � <br /> �THT� ' FORCEDAIRSYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KItCHEN SINK 8 DISP ; CLOTHES DRYERS ; <br /> DISHWASHER �- RANGE HOOD —T- <br /> LAUNDRY TRAY ' ' WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL � ME7AL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) ; <br /> FLOOR DRAIN ~ GqS FIFEPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE-BAR.ETC.) GAS PIPING � <br /> IXHAUST FAN <br /> i <br /> � � <br /> i � <br /> SUB TOTAL S ; SUB TOTAL t ; <br /> PERMII' S � PERMIT f � <br /> TOTAI FEE S ' TOTA�FEE S ; <br /> FOR QFFICE USE ONLY: <br /> i110NT5ETp�CK / RE�RSETBACK SIOESEIPAf.N/ � PI�NCIICCKNIIMflfll �f( �O f1fCFIPINO <br /> .S O ��5/� _ <br /> USE 20NE � IOT�REA yAC�NI SII[ FEES VALUATION FEE <br /> �' ❑ve oNo nuuni�r. SZ`i`/ ��'(' G� <br /> HEIG11fUMIT�T10N� � UN1I�OWELUNG 512EOfBlUG�I — ; <br /> Z ��o S.r. riuumr+r. <br /> OCCUP�NCY NO Of51ptlC5 OCCUPANiIOAD B�SEMENI � <br /> Gqqp A�ECIUNICA� � <br /> V -i I a,E, rr:� ----- <br /> FIRESPIiINKLEflREO'D REASON � �DDIIIONALPUNC11fGN <br /> _ _�__ <br /> 0111(Il <br /> _"'_—___ i <br /> FlREAURMREO'0 PE�SON — � <br /> � — S1Atf0UIl01NG511RpU06C _—'—"— _-- r 5�7,� <br /> rrreorr.or+sr rinNserrnovenev CITYOFEVERETT rumicwonKs ' <br /> LOCAL SALES ------ _ - --- _ _-�_------`— <br /> -�J o�rE;3 Z TAX CODE IS 9105 7oipL _ � `Sc� <br />