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-, <br /> /►PPLICATIO.d FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COAABINATION C BUIIDING G" 1AECHANICAL Q"PLUMBING ❑ SIaN <br /> PROJECT ADDRESS: <br /> !?YNe-� l�One.s �,�c �0909 .�2� � �oi/anis�/ 9�3290 3I.a 'SGPd83� <br /> pyA�Ep MMLADDRESS Cltt ZIP PIIONE <br /> TENANT u�Il�Ddi[55 CITY ZIP n��ONE <br /> AqL111TECTORDE5IGNER M�II�DpRE55 Lltt IIP �HONE <br /> 5,,H� _ �"�Cp'77Nc✓ <br /> GENEFA�CONiMC70R MqLA0DRE55 �d�Y llP PIIONE SUlE110ENSE� <br /> MECHANICAICONTRACTOR M�ILADORE55 Gtt 21P VIIONE STATELILENSE� <br /> MUYBMIGCONTRICTOR M�ILAWRE55 Cltt ZIP PIIONE SiAiEUCENSE• <br /> 9�7v� <br /> CONTMGT%YCEOFM✓JRN HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ <br /> CA�t/s/ oF ZS�'q sf t�i�Ea' B[d6 <br /> p[,aCRIpE WpRK 11N0 SOU�AF FOOTKaE WVOLVED CONT�CT PERSON�Ni]PMONE NO <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> /�TCS�l�lV�'F APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> movoseo usE oF e�n�ar+c PROVISIONS OF LAWS ANQ ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ��pQ$�q�p11p1pFP{10PEptt�^uHOWNBELO'MORARACNiN+JCOMES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TU GIVE <br /> �B�aK � fr T AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> 1O7 OTHER STATE OF LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> BF.f�6PL�I Pl�Q,C Pe.e Putl' ,PC�1 �Y P/ �r PERFORMANCE OF CONSTFUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 39�0�LiCt�J'O8/•�9 APPLICATION IS MADE AND I COIAPLY WITFi THE STATE <br /> FMCEL TAX I D.NUYBEN .^.ONT TORS LAW 1827 RCW AND 29fi.200 WAC. <br /> lY�d/1/[✓Gs7t� Mc�2i6AGE 2�Y.-77S•.�GZ(. �. <br /> CpN571NIC110N IOAN LENOEP,AWRESS.TELEP110NE NVMBER �� x 4�(O�5 b <br /> SIGN�TURE D�TE <br /> �29GB0 <br /> 7���� CITY BUS�NESS UCENSC NO <br /> ���� MECXANICAI <br /> p0. TYVE OF Fll(TURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> �j WATER CLOSET(TOILEn � A/C—A/HNDLG UNITS ' <br /> BATHTUB ' FORCED AIR SYSTEMS � <br /> LAVATORV(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' /� UNIT HEATERS <br /> Z KITCHEN SINK 8 DISP i CLOTHES DRVERS � <br /> Z DISHWASHEri � Q RANGE HOOD ' <br /> LAUNDRY TRAY ; Q WATER HEATER � <br /> 2 CIOTHES WASHER � WOODSTOVE ' <br /> URINAL ' AIETAL FIREPUCE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLAGE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN <br /> � GAS FIREPIACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.} GAS PIPING ' <br /> (� IXHAUST FAN <br /> � <br /> � <br /> � ' <br /> � <br /> � <br /> SUB TOTAL E � SUB TOTAL S � <br /> PERMIT 5 i PERMIi S � <br /> TOTALFEE f ' TUTALFEE E <br /> FOR OFFICE USE ONLY: <br /> p(qry75[7pAC1( REARSF]P� 51 S � �l�NC1�ECNNUu0ff1 fEf �Ef.fIPTNO <br /> Z '� �/ Q �4 <br /> � <br /> usezon ioteae� w ANt51fE FEES VALUATION FEE <br /> - l ❑ves ❑ �o nunon�r, /b'S' -��7 � <br /> NEIGNT UMITATI N NO Oi DWELLING S�IE O�OLDGR I �� <br /> , � O ur+irc // 7 yy S,F. Civ�N4 +' rtuMmr+G <br /> D L S,F .I2a�+E <br /> OCCUPANCY AV M 51(WCS OCCUP�Nf IO�D BASEMENI AIECIUNIL�I. �D � <br /> �""°?J/ Z ❑YE5 a� <br /> �DD��IONq.Pl AN C��f LN <br /> FIRESPRINKLEFFEO'D RF�SON . ---�— <br /> OlH@R <br /> FIREAIMMREO'0 RF�SO�i / � �in <br /> STAIE OUItOi�+G SIIRCI�ARGE ��L� <br /> TYPEOff,ONST �lANS�PPnoveqav CITYOFEVEREIT rnnnr,wonns ���.��'G'� ��Q _ __ �— <br /> LOCAL SALES �• `� <br /> -�� OAIE �1 y� (o TA% CODE IS 3105 70TAL <br />