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APPLICATI�.�1 FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION �AUILDING ❑ MECHANICAL p PLUMBING ❑ SIGN <br /> PROJECTADDRESS: �3;�� � U�/) �Jn ��-- <br /> 01MIER M�ILIIWRE55 CI7Y ZIP PMpNE <br /> r� �1 n v �' � r� ,. Po �� �n � y V rP-t-�- ��iA�Q3�$� <br /> TENMlT MNLIIDME55 ^ GTY IIP PIIONE <br /> �RLIIITECTOROESIGNER M/ULAOORESS Gltt 71P PHONE <br /> �cl�UiAy <br /> `_ENEfUL CONTMCTOR MNlMW1E55 dIY lIP PIIOI:E SMTE IICENSE� <br /> r c1�7 • � <br /> YECNMIICQCONTRACTql WUTApp�RLE�55 CITY ZIP PMONE STATEtICENSE/ <br /> T / <br /> PLUMBRMaCpHTR�CTOiI Y�ILAOORE55 CIrV ZIP PIIONE SfATELICENSE• <br /> �, lJ � � 1 � � , <br /> CON MCT PRI�E pF yyppl( /� <br /> �O�i��cT HEATING SYSTEM: �GAS O ELECTRIC O <br /> � �E� NDSOU OOTAGEWVOLVEO CONTCTPEqSONANOPNONElq <br /> � :� Ye S�. 'r <br /> // �'� <br /> �y�G /�7C I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> vnoroseo use oreeeuuuµ��pxx; APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � � {.,�� m � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � I WORK Wlll BE COMPLIED WITH WHE�HER SPECIFIED HEREIN OR <br /> �akoescnvrwHariarenn�s�a/wNee�owaa�rt�cHTwoca+�� � NpT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior____�e�ocK .�lD oF � �I i�1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI.LAW REGULATING CONSTRUCTION OR THE <br /> �' .3 PERFORMANCE OF COMSTqUGTION.THAT I AM AUTHORIZED BV T}IE <br /> OWNER OF THIS FROPERTY TO PERFORM THE WORK FOR WHICH <br /> � �� 3� y�n G l Pr ��� n APPUCATION IS MADE AND I COMPLY WITH 7HE STATE <br /> �rex i o.rM�eE � CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> O'� - G�/ -v '�v •�O <br /> CON57MIC7qNl �{NpER.�DD SS.TElEP1qNEM1MlER <br /> n�er' �,,,� 0�303- SI l�in <br /> an eus�r�ss i�ceNse r+o <br /> ���� MECHANICAL <br /> NO. TYPE OF FlXTUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET OILEn I � NC—NHNDL6UNfTS � <br /> BATHTUB ; / FORCED AIR SYSTEMS � <br /> LAVATORV(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK d DISP ; CLOTHES DRYERS ; <br /> DISHWASHER � RANGE HOOD � <br /> UUNDRY TRM' ; WATER HEATER � <br /> / CLOTHES WASHER � WOODSTOVE , <br /> �R�� ' MEfAL FIREPLACE(VJOOD BURNING) � <br /> DRINKINO FOUNTAIN i FIRFPLACE 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 S ; SUB TOTAL S ; <br /> � PERMIT S � PERMIT S � <br /> TOTALFEE S � 70TALFEE f <br /> r4R OFFICE USE ONLY: ,Q.�./` //7 <br /> iRONT SETB�CN � REM SETB�LK f SIDE SETB�1 Pll1N CIIEC� BE� � LEF,��/� RECFIPT NO <br /> �LC% [� (� <br /> I15E20NE�`� LOTAREA VAC�NTSITE FEES VALUATION FEE <br /> ❑res ❑ r�o aunoier. 2 Y'� I <br /> NEIGNi U�� TION 1q pF pW�I�IN('. 512E OF BIDGRI <br /> uNnS I 12gZ S�f. L�viNC� a- vwue�uc <br /> 52S r' GAKAtiS <br /> occuru+cr No tx sr,�veEs uccu�u�r�o�o e�seu�r+r � <br /> (pqp)P MECH�NIC�L / i <br /> �. ' � ❑YES YO b� <br /> FIPE HINKLENREO'D REASON �OD�iION�LM�NG�ICCN —�i-' <br /> OINE{i � <br /> FIREMMMREO'D RE��ON � <br /> SfAI[BWl01NG SIIRCIIMG[ <br /> _" �y.Z� <br /> TYPEOFf,pNST PLANSAPPROVEDBY CITYOFEVERE7T rueucwon�s /f� <br /> LOCAL SALES �=��— <br /> �-^� D�TE TAX CODE IS 3105 TOTAL <br /> V ' <br />