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��, <br /> APPLICATIG.� FOR CO:VSTRUCT.JN PERMIT <br /> CITY OF EVERETT• BUILDING OIYISION � <br /> 3200 CEDAR STREET•EVERETT,WA 9Bp01 •259•8810 <br /> ❑ DEMOLITION p COMBINATION [� BUILDING �IIIECHANICAL ❑ pLUM81NG ❑ SIGN <br /> PROJECTADDRESS: �C� �� ����� �[nr.��_ /� �/��� -t���� <br /> OVMER MML�OpiE55 pTY .'I� {`HONE <br /> ' ' � /� /. / � � <br /> �v / <br /> T NANT ' l�OIX1E55 LIIY I�P ?NOXE - <br /> y�,FmAr� T�/n�S <br /> eqLM1TECT OR DE5IGNFR MNl ADDRE55 GTY T�� PI� NE �����/� /� � \ <br /> -'1 y�� � <br /> �GE Ef1l�L GONiR�CTOR MAII ADIX1E55 LiT Im P N SU[l ICENSE� � / <br /> �.l���a�Cx ��oa / !� = �°S��o� 3� r�i�Y� � <br /> � C NI��LCONTR�CTOR M�IIl1DDRE55 f.ITY ZIP PIIONE ST�tELICENSE• <br /> PIUMBINCCONTR�CTOR M�ILADpHE55 GITY ZIP PHpNE SiqEIICENSE• <br /> CONTRACT PMCE OF WORN e}_, _ <br /> !t J� HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> DESCRIB/E WqiN��/p_Ip$p/yµE F INYOIVED ( CONT�CT PERSONAN�PNONE Np � <br /> (lifi ST� I l 'l�4 � '/ <br /> i``Pc_�' � ` . <br /> � c <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> rRoroseo use ov em�arxi APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WIIL BE COMPlIEO WITH WHETHER SPECIFIED HEREIN OR <br /> LEG/�LOESGRIPTIONOFP{qpERry�,y�pWrygE�pWpq�Tikl/TVqCOPIES) NOt THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�oc� pr AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROP RTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS AD D 1 COMPLY WITH THE STATE <br /> r�acttiiNci.D.wuMeea � � CONTRACTO AW C AND2g6.200WAC. <br /> CONSTRUGIIp:IOIW LENOER.�DqiE55.TELEi'110NE NUMBER ' � �� <br /> X <br /> SIGN�TU D E <br /> CITY BUSINES$UCENSC NO <br /> PLUMBINO MECXANICAL <br /> NO• TVPE OF fl1(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—/VF{NDIG UNfTS �— <br /> _ BATHTUB ; FORCEU AIR SYSTEMS � � <br /> � <br /> LAVATORY(WASH BASIN) � HEAT PUMP � , <br /> SHOWER � UNIT HEATERS ~ <br /> KITCHEN SINK 6 DISP ; CLOTHES DRVERS ; <br /> DISHWASHER � RANGEfi00D i <br /> UUNORY TRAY ; WATER fIEATER � <br /> CLOTHESWASHER � WOODSTOVE , <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPIACE <br /> BACKFLOW PREVENTERS � GAS RANGE � <br /> SINK(SERVICE—BAF,ETC.) GAS PIPING � <br /> ' FXHAUSTFAN <br /> � <br /> � � <br /> i � <br /> i <br /> i <br /> � � <br /> SUB TOTAL 5 � SUB TOTAL S ' <br /> PERMIT S PERMIT E <br /> TOTALFEE S � TOTALFEE E <br /> FOR OFfICE USE ONLY: <br /> iRONT SETp�Ck RE�R SF.TB�CI( $IpE SETB�CM PLAN CIIECK NUMBFR fEf RFf.FIPi NO <br /> S2�C�� <br /> U�E20NE IOI�REA V�C�NISIfE FEES VALUATION FEE <br /> _ ❑YES ❑ NO OWLOINb <br /> i <br /> HEIGIR UMIUTION NO OF OWEILING S12E OF 9LD�rtt <br /> UNItS <br /> PlUlA01NG <br /> OCCUP�NCY Np(%SIMi(5 OCCUPAM 10�D BASEMENT � <br /> GPWP MECN�NICAI <br /> ❑YES ❑NO <br /> FIRESPRINKLERREO'U I1F�SIXJ ADDIIIONA�PI�N�IICGN <br /> --i-- <br /> on��n <br /> FIREAIARMREO'D RF�GpN <br /> STAiB BUqOMC SURCMRRGE <br /> imEorr.oNsr rinrus�rrne�,-.ner CITYOFEVERETT runi�r.wonKs <br /> LOCALSALES <br /> o�iE TAX CODE IS 3105 TOTAL <br />