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APPLICATIG_� FOR CONSTRUCT �JN PERMIT� <br /> CITY OF EVEflETT• BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION O COMBINATION ,� BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br /> PAOJECI-fF�6 E�/�-�� I ��USC. �✓�2EtT /Y1.4LL G✓8 y 92�GI d' ` <br /> r� p <br /> /Nt �• . �.0� pIG� GVALN� e�.�}. qS�.s�I� Cs7o)f/F�- 3e6 <br /> pryryE� MMlA00RE55 Cltt ZIP PNONE <br /> 30��,✓� , <br /> iEN�NT IIRIlAODfiC55 GIIY IIP P110NE <br /> �a�ri✓�. <br /> �ncw*eer on oesicr+ea uui�ooness cirv ��r rHor+e <br /> C'-A-ticLri y ����/ _ <br /> 4ENEMLGONTR�C pi M�Il�0�f1E55 CIIY )iP P�IONE $GiEUCENSE� <br /> MECH�NICALCONTRACTOR MAIIADORE55 f.ltt ZIP P/IONE ST�iELICENSE� <br /> PIU�AB111GCONiRACIOR MUL�U0RE55 GILY 21P PNONF. STATEIIGENSE� <br /> CONTMLT PRiCE OF WORN <br /> �2 06G HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br /> �ESCRIBE VlORK AND SOUAPE FOOTAGE INVOLVEO CONT�CT{`[I150N AND PHONE NO <br /> c�s�-r� c�.�s,��ms us�Na�� �r��eo�Kr a66- 3S�'� <br /> I HEHEOY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT ALL <br /> PROPOSEDUSE OF BUILUINO PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br /> D�F/G f WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> . LEGALOESCRIPTIONOFPROPERttISNOWMBE:OWOR�iT�CHTWOCOFIE51 NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOCK _OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � OTHER STATE OR LOCAL LAW REGUTAT�NG CONSTRUCTION OR TI1E <br /> � PERFORMANCE OF COh'STRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THC- STATE <br /> PNiCELTA%I.D.NUMBER CONTiiACTORS LAW iB.27 PCW AND?96/.2�00 WAC. <br /> CONSTRUCTIONLOMlLENUER.A�DRE55.iELEAl10NE NJMBER x C./—° ' �`�/. /L'sfZj�'"" '- �fL/J/✓L <br /> SIGNniURE O�tE <br /> Cltt BUSINESS LICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> T <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNRS ' <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY 7RAY � WATEfl HEATER i <br /> CLOTIIES WASHER i WOOD STOVE ' <br /> URINAL ' MEfAL FIREPU�CE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREP!ACE INSERT(WOOD BURNING) i_ <br /> FLOOR ORAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTEHS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING ' _ <br /> EXHAUSTFAN <br /> � <br /> � <br /> � <br /> � ' <br /> SUB TOTAL E � SUB TOTAL 5 <br /> PERMIT $ i PERMIT S � <br /> TOTAL FEE 5 ' TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> (RONTSEID�CN REAfiSETBACN SI�GSEI6�CN �UNGIIECNNUMO[Il fEE �ECE��'TNO <br /> usezone iorenen v�c�r+rsrte �� FEES VALUA710N FEE <br /> ❑rE5 ❑NO l � <br /> OUILOWf �F ��� - � i�v <br /> MEIGI/TUMIiATION NOOFOWEILING 512EOF6LOCRI � <br /> UNIf$ (� I � � PLUMOING � <br /> � � <br /> OCCUPANCY Np Oi SIOPiES OCLUPANI lOAD 9�SEMEN7 MECIInNICN. i <br /> GROUP � <br /> 35 ❑1'E$ NO /J � <br /> FIRESPRINKLEAREO'D OE�SO"1 AOD���ONALPIANCl1[LR / : /I�1 <br /> �T" <br /> /�U on�en � <br /> FIRE/dAPMREO'0 RE�S(N1 � <br /> N� STAEOUII�ING511pCllAfifE —_ � �_ <br /> rrceoFr.oNsr rinnser o�oor CITY OF EVERET� ruonr.wonKs �_ <br /> � � � � ��� LOCAL SALES — <br /> o.ie i L-i0_ -� TAX CODE IS 9105 7oTAl � _�.� <br />