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APPLICATII.i FQR CONSTRUC7 .�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> , 3200 CEDAR STREET•EVERETT, WA 98201 •259•BB10 <br /> ❑ DENlOIITION t�9 COMBINATION ❑ BUItDING ❑ Pd!ECHANICAL ❑ PLUINBING ❑ SIGN <br /> PROJECTADDRESS: �lJ�/C�T SG/Vc' �E �f��`�f �B��p <br /> ONTlER 4�IL�DORE55 LITV ZIP . PNONE <br /> ,E'i�o�N (o�/s9/�oZi /OY// 3es-� S���e,�t 9d'� �CC�3�17Y77/6 <br /> IEW/�WT MNlA0ME55 �/ CIIY / IIP pi�pqE <br /> /•^E�$19�✓ �O...S�n �� n ..� � $ � �I. OGX �� U�i ��Nrr /',l�;f 1027 .Ci 77J-� .SGQ ' <br /> �RCPoTEGttN10E51GNER MqI/�WPE55 � Cltt 21P r nNONE <br /> GENER.4CONfRACTOR MAll�00RE55 CIfY pm PUONE SUIEIICENSE� <br /> n �., N �.� /,e�.. 'i �p ti ,� � L e� <br /> MECNANICILLCONTRACTOH MNIADqiE55 f.itt plP PIIONE STREUCEN$(� <br /> PlU1ABINGCONTR�.TOA M�ILADDHE55 Cltt llP PHpNE STAIELICENSE� <br /> CONTRAGi MqCE OF WOfIN - <br /> S�O�-� HEATING S`,'STEM: B�GAS ❑ELECTRIC ❑ <br /> UESCRIlENVRKANOSW�RE OCTApE1NVOlVEp I:ONTAGTPER50NNIpPIpNENp <br /> `�'!v� ,�.f�� 3 � <br /> 7Z �C ZZ- � HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> v�ovo.:¢o us¢or euu.ara APPLICATION AND KMOW TI1E:,AME 70 BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND OHDINANCES GOVERNING THIS TVPE OF <br /> �a��k�PT�O�O�P�OPERTY13N01M�9ElOWOqATfA�MiWOCOPIE51 WORK WILL BE COMPLIED WITH WHETHER SPECiFIED HEREIN OR <br /> � NOT. THE (iRANTINd OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �aT� e�uc�c oF � n AUTHORITY TO VIOLATE OR CANCEL THE PROVIStON OF ANY <br /> �T �VC � OTHER STATE OR IOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> f J9 '� PERFORMANCE OF CONSiRUCT10N.THAT I AM AUTHORIZED BY THE <br /> 1 " OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH <br /> � W�ASwIHl�J}�jGL APPUCATION IS MADE AND I COMPLV WITH THE STATE <br /> WWCELTNf 1.0.M1MlER � CONTRACiORS LAW 1827 RCW AND 298200 WAC. <br /> l Clvi��S—o7i�GbC/� �c`J� � <br /> CONSTPVCI7(MiIQNlIENDEN.l1WRES5.TElERqNEMUMEER x �G� � �, i�'� V` �C-a41/E�(/ C_ <br /> �� 1 llo <br /> SI6N�TURE � D�/E <br /> qtt BUSINESS IICENSE NO. <br /> P���� MECHAN�CAL <br /> • ' NO. TYPE OF FlIfTURE Oq ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> ;' WATER CIOSET(TOILEn /' � <br /> � NC—AMNDLG UNffS � <br /> BATHTUB � ; FORCEDAIRSYSTEMS � <br /> LAVATORY(WASH BASIN) ' <br /> � HEAT PUMP , <br /> SHOWER � � � UNITHEATERS � <br /> KITCHEN SINK 6 DISP — i CLOTHES DRVERS ` ; <br /> OISHWASHER r � RANGE HOOD _ , <br /> UUNDRY TRAV — ; WATER HEATER � � <br /> CIOTHES WASHER — � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKINGFOUNTAIN i FIREPLACEINSERT�WOODBURNING) � <br /> _ FIOOR DRAIN � � GAS FlREPUICE � � <br /> BACKROW PREVENTERS ' GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS pIPING , <br /> IXHAUST FAN % <br /> � � <br /> � <br /> � — , <br /> � � <br /> � <br /> SVB TOTAL f ; SUB TOTAL S J� '� <br /> _ PERMIT S � PERMIT S /�1.� � <br /> TOTAl.FEE f � TOTAL FEE S <br /> FOR OFFICE i1SE ONLY: <br /> iRONTSETp�CK pE�RSF.TBACK S�DESETB�CN PI�NCNECNNUUBF.R fEF RECEIPTNO <br /> ?�C" � /O �P/I �� O,i r c�3' �' �1���-'� <br /> usexor� lO1�REA wc�Nt;dte ,� FEES VAWATION FEE <br /> �f/ ❑YES ❑� OUILDMG 6 2 ���I /T— <br /> HEIGNT L�MIf�TIQy � NO OF DWEILING S�ZE OF BLIX:R.L J ''l <br /> Z�J UNIfS Z YL �F Gq��4` PIUTABINO � (�� ; <br /> CJ <br /> WCUPANGY 1q OiSIMbES OLCUP�NfL0�0 B�SEMFNT <br /> GRIX1P MECM�NICAI � <br /> R•3 �_ 2 o.es m7+o �0 ' <br /> FIRESP NKLERPEO'D REASON �DD1110N�LPUVp�f,�R �(� �J <br /> � 2 <br /> on�en <br /> Flii ALMMNEO'D RF�SON <br /> Si�1E AUILOWG SUfIC11�IiGE ; .{� <br /> N <br /> rrcear,or+sr mnNs�vv.aJov�Eypar CITYOFF_VEREtt ruenr.wonKs — _ r _ <br /> N LOCALSALES �U�-- <br /> —'J,! n�iE�j �O (p TAX COD�IS 9105 TO7AL ii,31 ' ���� <br />