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APPLICATI��� FOR CONSTRUCI ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> , 3200 CEDAR STqEET• EVERETT, WA 98p01 •259•881C <br /> ❑ DEMOUTION ❑ COMBINATION I�C'U�LDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS:_ 1 pgp'3 f 5� iQve S� <br /> OWNER M�ULAOORE55 Cltt 21P VHON[ <br /> T��UC ¢ �jDNN�E �CS� 106b3 ! u.4vc $E EvEee.'r �i87DP� 3�-7 5869 <br /> uu��ooness uTr <br /> l�P FI�ONE <br /> AI'.CMTECTORpESIGNER MNI�DDqE55 ��ry <br /> TI� PIIONE <br /> GENEMICONTMCTORn. M�ILAUORESS CIIY zm <br /> PAGfiL � �\ PIIONE Gf�fEIICENSE� <br /> A � �C IOIIO CR��EL O2 tVL-'�2LTT WA SSj,j)I ZSy ls'l l P,QGF61 ��SStiJ <br /> MFCXANICAICONTRACTOR MAlIAppRESS Q7Y ZIP PIIONE SUTELICENSE� <br /> MUMBINGCONTR�LTpi MMIA�pRES$ Cltt IIP PNONE <br /> STAiE LICENSE� <br /> GONTqACi PRICE OF WO�qf'' <br /> /O`>�� gE'��• p`� HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OESCRIBE NV11K�NO$OUAqE FOOTAOE INVOWED CONT�CT PERSON�ND PNONE NO <br /> �o.usr�wcr 576� DE?!1cr1�v� G4.e46� �o a�so,.i zs9�� >> i <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> rnor�oseo usE oF eu�proo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br /> C�A e•�'L PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ���k�MPT�ONaPfiOPERTYI�MM6ElOWORATTACHiYpCOP1E5) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHF.IN OR <br /> �� NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T—�--�0� � / AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> � L �� J�'�� `.- �/c�i� ti. PERFORMANCE OF O STRUCT ON.`THAT�I AM AUTHOHIZED BV THE <br /> `� OWNER OF THIS PROPERTY TO PERFORM T}1E WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> °i��T���o�M�p CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �1JS'ODU 62fo 00[�`3 X- �CYC.J �f`� 6/Z3"/S� <br /> CON51�X1C110N IOAN LENOER,�DqiE55,IELEP/10NE NUMBER <br /> C H SN3N�NRE O�TE <br /> CITY BU9NE55lICENSE NO <br /> �V�� MECHANICAL <br /> MO• riPE OF FlXTURE OR ITEM FEE NO. TYpE OF ECUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—NryNDLG UNffS i <br /> BATHTUB ; FORCED AIR SYSTEMS � <br /> UVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER � UNITHEATERS , <br /> KITCHEN SINK d DISP � CLOTHES DRVERS <br /> DISHWASHER � RANGE HOOD <br /> UUNDRV TRAY ; WATER HEqTER � <br /> CLOTHES WASHER � WOpD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) ' <br /> FLOOR DRAIN � GAS FIREPLACE , <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS P�PING , <br /> ' IXHAUST FAN � <br /> � <br /> i <br /> _ � <br /> � <br /> _ SUB TOTAL f ; SUB TOTAL f 1 <br /> PERMIT S � PEHMIT S � <br /> TOTALFEE f � TOTALFEE S � � <br /> FOR OFFICE USE ONLY: <br /> ��T�TB�CK AEANSETOACK SIOESETB�CIt PLANCIIEC�i�ER !EF /f� /n RECFIPINO <br /> 2� � .S � �0, 'F' .S C� � L. <br /> USEZONE IOT�REApr 9 veCeqrsrtE FEES VALUATION FEE <br /> �' � '7� U.7j� ' ❑YES �O pl1Il01NR <br /> HE16NT LIMIUTION NO OF OWELLING SRE OF BlD6R1 <br /> ZCv � <br /> 7� UNIfG ✓ � ��� �� plIlA101NG � <br /> a�U��NCY NO(%SI(VtlES OCCUP�Nf LO�D 6�5EMENT �� MEGHIINIG�L � <br /> V' ❑YES �NO <br /> FIRESPRiNKLERPEO'0 REASON �DDIIION�LPUN�BF.Ck � <br /> ou�en � <br /> FIREAINiMNEOD f.E�SpN <br /> SiA1E OUII OINO SIIRLIUpCE !rT. <br /> Ll V <br /> TYPEOF�pNST rinNserFRpyEDBY CITYOFEVERETT runur,won�s _ <br /> 1 <br /> ;�^�� ��F� LOCAL SALES Z�_� <br /> JL o�rE S � TAX CODE IS 3105 TOTAL ,.� <br /> / I�o l�� <br />