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APPLICATIQ�' �aR COIdSTRUCT`�Ri PERMIT��}�. <br /> CITY OF EVERETT•BUILDING DIVISION �/� <br /> 3200 CEC AR STREET•EVERETT, WA 98201 •7�9-8810 `C�]-- <br /> ❑ DEIYIOLITION ❑ COMBINATION �Ti BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SICaN <br /> PROJECT ADDRESS: 3 L <br /> A�p �� �tl� MNLADOfi�E/5 L� �KP� ��� / PIION�a -9�9� <br /> TEN�NT MAILADUfiE55 f.ITY TIP P��ONE <br /> /V� _ <br /> ARLIIITEGT OR D1ESIGNEN M/Jl I�DORE55 CITY TiP PNONE <br /> GENERAI JC I^Tf�A�OR M�IL�DORES$ (:IIY lIP PIIONE SIRE IICENSE• <br /> aV T <br /> MECHANIC/�LCONTR�CTOR M�ILAWf1E55 f.ltt ZIP P110NE STATEUCENSE� <br /> PLUMBNC�R�CTOR M�IIADDRE55 CIIY Z�P PIIONE STATELICENSE� <br /> N�- <br /> I;ONTMGTPPoCEOF WORK HEATING SYSTEM: ❑GAS ❑ ELECTRIC f�. <br /> DESCPoBEvp�ANO SOUARE FOOT�GE INVOlV4D1 �7 f.ONT�CTp ENSON��+�PMp NE NO a _ q r q <br /> �„�dryF;�T+�. u,tnli. PXlfil','� !Yr'S�cle/,u c G /�,,C/*_'l Du�.il S m. `� � _ <br /> �O (�1 A/- ' � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7 ALL <br /> vraroseo�se oF au�ar+ca PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ` WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LECJiI D�ES�CR,IP�T7ION OF P110PEHTY I�OWN BEIOW OR ATTACH TWOiCfy-.v�esl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT�L_etocK�3� ov��/, � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ���S���6 �� �,Q 7� /_ y—� ���j� � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> =�� OWfIER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> y3 9/'� 7— DQG ^� �� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> PAHCELTNfI,D.NUMBEN /// /..�- <br /> CpJSTRULTIONIO�HlENOER.A00RESS.TELERIONENUMBER x�-�� �• N�/I'/i(N" IO/S/96 <br /> SiGN�TUflE UAIE <br /> CIiY BUSINE55 LICENS[NO <br /> PLUMBIN6 MECHANI�AL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILETj � A/C—A/HNOLG UNRS ' <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SFIOWER ' UNIT MEATERS ' <br /> KITCHEN SINK d DISP � CLOTHES ORVERS � _ <br /> DISHWASNER � RANGE HOOD ' <br /> LAUNDRY TRAY ' WATER HFATER �_ <br /> CIOTHEuWASHER � WOODSTOVE <br /> URINAL ' MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING� i <br /> ROOR URAIN GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GA£PIPING ' <br /> EXHAUSTFAN <br /> � ; <br /> � , <br /> � ' <br /> � SUO TOTAL S ; SUB TOTAL E ; <br /> PE:RM�T 5 � PERMIT S � _ <br /> TOTALFEE f ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: Z(! � a- ' <br /> F110NTSETpAGK RE�RSF.7BACK SIDESETB�CR Pl�NC11GLRNUMpPR ffF RFCFIPiNO <br /> �� � �7.�. � <br /> , <br /> usez E � �oT�ne.. vec�Nrsue FEES VALUATION FEE <br /> � - ❑vEs �o nunnwr. J—i'�� µc�- I�� <br /> MEIGNTLIMIT�[ION NO OF OWEIUNG S�ZE O�OIUGRI n'y � <br /> // UNII$ 1 PUIMOMG /��a <br /> O / �Z`f� s.f. E.%1S'74 --� <br /> OCCUPANCY NO(%SIMiES OCCUPI1Nf LO�O BASEYENT � � A�EC11ANif.eL <br /> G�� I ❑YES LY�+n — - � <br /> FIflESPNINK AREO'D <br /> RFASON /•ODIIIONN �IANCII(CN � -- —__T_ <br /> 0 UlllE11 <br /> FIREMMMR60'0 AFAt(N! ^ <br /> $TAlEAU1lDR1651111CIUliGE L ���/ <br /> v --- - -- <br /> TYPEOFCONST PI�N$�PMIOVEOOY CITYOFEVERETT P11011f.WOi�KS � <br /> LOCAL SALES -'--- J��,,,� <br /> �- N o�iE (� ct TAR COUE IS 9105 T�TA� � � <br />