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APPLICATIOti FOR C�NSTRUCTI.�N PERMIT <br /> CiTY OF EVERETT• BUILDING DIVISION <br /> 3200 CEDAR STREEf• EVEREiT, WA 98201 • (425) 257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL GY�UMBING ❑ SIGN <br /> PROJECT ADDRESS: �, I I `(�� p�}i c��,-y L C��� J�; <br /> �;tlar- 2 17,-, �.�G�� .-✓! 2 // �/Z�x,ti.�.G�/_,�— �/�z�/ 9z� zy2 -�sqi <br /> OWNER M� A ' E55 �Itt IiP VHONE <br /> '��^/7� <br /> IENANT MMI.ADORE55 LITY 71P p��ONE <br /> AR�HITCCT OR OESIGNER M�II�DpPE55 C17Y )�P PNONF <br /> GF.NEML GONip�GTOR M�11 AUORE55 CIIY )iP Pil04E GIAIE lIC[NSE� <br /> MECH�NICA/1 ONIR�CTOR A1M��DORE55 CITY )IP P110N[ Si�TF.IICENSE� <br /> J <br /> PWMBMGC0117RACTOR M�ILAOqiE55 Cltt llp PNONE $TATELICENSF� <br /> CONIRACi PRICE OF WpRK <br /> HEATING SYSTEM: is7-6'AS ❑ ELECTRIC ❑ <br /> DESCRIBE WORK ANU 5 U� E T�GC INVOLVED n CONTAGT PCRSON�NO PNONE NO <br /> Gf/ I HEREBY CEFTIFV THAT I NAVE READ AND EXAMINED THIS <br /> PROPOS. US�OF ILDING „ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLl <br /> PROVISIONS OF LAWS ANQ ORDINANCES GOVERNING THIS TYPE OF <br /> ���— WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> IEG�LDESCRIP IONOFPRp RTY�SNOWNBELOWORATTACNTWOCONES� NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT e�ceK ov AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEPFORMANCE OF CONSTRUCTION.THP.T I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICN <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PMCEL TA%10.MIMBER CONTRAC70R5 AW 1827 RCW AND 296200 WAC. <br /> CONSTPtKTION LO�N IENDER,IIDONESS.TELEPHONE NVMBER X_ �iyi_�/✓ ���j //y/ ?/y � <br /> c_aar <br /> SIGNATVflE ���� / <br /> CITY BU51NE55 UCENSC NO <br /> • � PLUMBING MECHANICAL <br /> � NO. TVPE OF flXTURE OR ITEM FEE NO. TYPE OF ECU�PMENT FEE <br /> ' WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS � <br /> � BATHTUB ; FORGcD AIR SYSTEMS ; <br /> LAVAtORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS <br /> �l KITCHEN SINK d DISP � i CLOTHES DRVERS � <br /> DISHWASHER � RANGEHOOD � <br /> ✓ LAUNDRY TRAV ; WATER HEATER ' <br /> CLOTHES WASHFR i WOODSTOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFIOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING �— <br /> � EXHAUSTFAN <br /> _ � ' � � <br /> � � <br /> � ' <br /> � <br /> SUB TOTAL E 2 � SUB TOTAL E � <br /> PERMIT E V � PERMIT S <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> FnR OFFICE USE ONLY: <br /> fRONTSFTp�CN RF.�RSF7B�CR SIDESEf9�CN PlRY�11EGKNUMHfR PFF �FCFIPTNO <br /> ����JS <br /> ttsE ior+F 101�REA v�c�r+r sire FEES VAWATION FEE <br /> ❑vE5 ❑ �+O --� <br /> PUIIDiNf. <br /> NEIG��itIMIlATlOY NOOFDWELLING SIZEO�PLOGRI <br /> IINI I V PI UA�OINO <br /> _____ _ __.'_— _."_-__.__—�— <br /> OCCIIPANCY N�N Slnnif5 IX:[IIPRNI LO�D BASFNENI MFCIInNiCnl <br /> GROU1' <br /> ❑vF5 ❑ NO -- — —'--_` _'_ <br /> PRESPRINKLG(iREO'0 �F�iON �DO1110NALPlRNC11ff.K <br /> ou�¢n <br /> nne nv,rM neo�o apnsnv - <br /> suir uuno�ar suncimnrc <br /> �mEorr;or+s n�.nNSnrraovEoor CITYOFEVERETT runur.waixc <br /> LOCAL SALES -- ----� �-- <br /> oAtE TAX CODE IS 3105 TOTAI _ '___.��._ <br />