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�. <br /> APPLICATI4.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLJTION ❑ COMBINATION ❑ BUILDING � MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: J��05 I 5T �� �� <br /> OWNER MMI/�WRE55 qTY Z�P PNONE <br /> `�„� �a�v�,s u�0 S I�T l7r S� ��a�}�- 9g.���" 3y7- i3C1(� _. <br /> iElUNT MAILI�OdiE55 GTY 21P PIqNE <br /> �qLMTELFOR0E51GNER M�Il/�00RE55 Cltt ]IP PNONE , <br /> �37����,,��,d .— <br /> GENEMILONTMGTON MAILI�WRESS CI1Y T�P PNONE SUTEIICENSE• <br /> MECNMIILAICOHTRACTOR MAILADORE55 Cltt ZIP P110NE STATELICENSE� <br /> PWMBMGCONTR�CTO{I M�ILADDiiE55 CIiY 21P P110NE STATELILENSE� <br /> CONiRACTPIMCEOFWORN HEATINGSYSTEM: ❑GAS ELECTRIC ❑ <br /> 21/ /.�2 — <br /> pE$Citle€WOqN�NO5IX111RE pTAGEINVOIVED CONT�GTFERSONANDPHONENO <br /> A�d., o�e be�lc-c�Fr� . � <br /> �n n r '� ' '� <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATI04 AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vaovoseo use or ewiawo pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> IECILLDESCRIPTIONOFPiqPEN�Y1�p�����ATThGNTWOCOPIES) ryp7. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ipT �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATIN6 CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.TMAT I AM AUTNORIZED BV THE <br /> OWNER OF THIS PROPEFlTY TO PERFORM TME WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> WwcE�T�ttio M»�R CANTRAGTORS lAW 1827 RC AND 296.200 WAC. <br /> 3g/5— D 'O — � C , �, �n g,,,.v 3-�s-9b <br /> CdISTR11Cllp!lOM!LENDER.AOOIIESS.TELERIONE NUMBER x� <br /> SIGNIITURE O�IE <br /> CITY&ISINESS LICENSE NO <br /> � ' P�V�� MECHANICAI <br /> � NO, TYPE OF FlIITLRE OFi ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � NC—MHNDLO UNITS ' <br /> BATHTUB � FORCED AIR SYSTEMS � <br /> UVATORV(1NASH BASIN) � HEAT PUMP ' <br /> SHOWER � ,� UNIT HEATERS <br /> KITCHEN SINK 8 DISP i CLOTHES ORYERS � <br /> DISHWASNER � RANGE HOOD ' <br /> UUNDRY TRAY � <br /> WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(W WD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS � GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING ' <br /> � �, IXHAUST FAN � <br /> i � <br /> � <br /> � <br /> SUB TOTAL f � SUB TOTAL S i <br /> PERMIT S i PERMIT S � � <br /> TOTALFEE f � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> Fqp�Tg7pA�1( � RE�RSFTB�CK SIDESETB�CIt / PtANG11ECNNl1�ER fEf � ^ b RECPPTNO <br /> ��� � � � �� / �� <br /> ��� <br /> USE IONE ) lOT�REA VeC�Ni 9fE FEES VALUATION FEE <br /> /) i <br /> // � / ❑YES ❑� BUIlDIH6 -z, � -" <br /> / /� <br /> HEtGNT L�MIT ON � UNrt���uNG SIZE OF BLOGR� � p1U1.1PING `� <br /> 4 / <br /> p��PANCY NOlNSi(MX6 OCLUP�NTLO�D B�SEMENT / MECN�HIL�I �/) � <br /> ❑vE5 H�+O � <br /> K -3 �DDI110Nq f`LAN LIIFCN ' <br /> FlRESPRINKLEflREO'� AF.�SOM � <br /> O111E� <br /> FlREMARMREO'D AE�Sd+ ST�1EflUIlDiN051111C11nOG[ — 1 /! i <br /> ��`�_ <br /> rrvEo�r,or�sT vinNs�rvr�oE_qer CITYOFEVERETT run�ir,vronK� _ �_ <br /> p� LOCAL SALES � —� <br /> oere � 2 b fAX CODE IS 3105 ToiAL <br /> �/;� ,JD <br />