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APPLICATI(11 FOR CO{�dSTRUCI ON PERE1111T <br /> CITY OF EVERETT•BUILOING D�VISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION �, COMBINATION ❑ BUILDIN ❑ MECHANICAL ❑ PLUI�IBING O SIGN <br /> PROJECT ADDRESS: ' I � Z I!'U-�—��P _ <br /> OYrt1I4�it .1 M�I SS GI� Im P11JME — <br /> Kfi.l.�n IOPGt �e ���ro7i� �.S Z -/3�/ <br /> tE r �; ` wui�non[ss arv y tia r�wr+� <br /> ��-/!l <br /> ARLNR[CT OR DE51(i 1EP \ wut AODnE55 c�tt )m m�pNF <br /> I! / <br /> GENER/iL ONtRKTpi MNL, �(55 C--- tif` PiIONF._ ,^ St�ll N������ <br /> '� 3 6L <br /> YEp1ANIC/�LCONTMLTOi1 MNIMORE55 CIfV ZIP P110NE ST�TELICENSE� <br /> PlU4! ONTR Tdi M11R 55 CII ZIP PIIONE STAIE LICENSE� <br /> CONiMCT PRI(:E OF Nqlllf <br /> GG� `'J HEATING SY TEM: �GAS ❑ ELECTRIC � <br /> DESC(IIOENORI(�NDSOUMEfOOTAOENVOIVED ID CONI�CT E SON PIqNF. /�� <br /> W ✓! <br /> � �-�. ��S'- 3&zZ. <br /> S � eS I �� I HEREBY CERTIFY THAT I HAVE READ ADlD E%AMINED THIS <br /> ��p����� � APPLICATION AND KNOW THE SAUE TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEMLOESLRIPTN7NOFPiqPER1Y�51qN71BElOWpiATT/�LH7NqCOi'IES� (�pT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or "� '�� e�acK�oF -r AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR IOCAL LAW HEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUClION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEFTY TO PERFORLt THE WORK FOR WHICH <br /> APPL O IS MADE AND 1 COMPLY WITH TNE 5111TE <br /> p,wcE�T�y�q�+�q /� C TRAC LAW 1 2 RCW AND 296200 FC. <br /> /��d� c�Lv o/6 OOOCo -- <br /> CON�IOAN LENOER.IIDDRE55.TElEP110NE MIMBEP � I <br /> SIGNATUPE UAIE <br /> Qtt BUSINESS UC[NSE NO <br /> PLUAIBIN6 MECHANICAL <br /> NO. TYPE OF FlXiURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET) � NC—NHNDLO UNfTS � <br /> � BATMTUB � FORCEDAIRSYSTEMS ; <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP � CLOTNES DRVERS � <br /> DISHWASHER � RANGE HOOD � <br /> UUNDRY TRAY ; WATER HFATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) i_ <br /> DRINKING FWNTAIN ; FIREPLACE INSERT(WOOD BURNING) i <br /> ROOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPING � <br /> IXHAUST FAN <br /> � <br /> � ; <br /> SUB TOTAL f ; SUB TqTAL f ;_ <br /> PERMIT S � PERMIT f � <br /> TOTAL FEE S ' TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRMltSEiR�CN REARSET811G8 SIpESEiB�Ck CI�NCII[CNNUMOff1 fPl �(G�IPTNO <br /> 5390 ��o,�— <br /> USEIONE IOIAREA veceN�srtf � VALUATIOH FEE <br /> --T— <br /> ❑ves ❑so nunnn+a 'Z� WD _j�7 � �, <br /> 11&IGIIIIIMITATI(NI NO OFDWCIIIN(: SIIE W OIIK�1 —"--"—'�— '—'�-- . � <br /> uNns �-1U5 1� riuunw�----- --- -----' -- <br /> _ — �`�, G � <br /> �UP�NCv Iq M SIM6 OLCUP�NI LO�D BASEMI�NI � MfC11ANlCeI � �� <br /> �' ( ❑vE5 IWu) '--_ _—__"__ _" /.�.�—__ <br /> FlRESMIINKIEflNEO'U RE�SON -- �DDIIION�I.PUNCnfGN <br /> __ _�� <br /> on�en ; <br /> Flf1EA1MMRE0'D RE�SON —'-- <br /> STA1E OUIl01NG51111CI1M1(:C i i��� <br /> ___.—__ �._ <br /> trrear'r,or+st oinrus�rrnovEnar �y. CITV OF EVERE7T ���mnr.won�s � <br /> �� LOCAL SALES � <br /> --- --- . ._ -- — -------'— <br /> - oeiE �j7 TAX CODE IS 9105 TOTAL ___ _ ��j� �,\v <br />