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,�. � <br /> APPLICATIOh FOR CONSTRUCT11.�1 PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 '���" <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ECMANICAL ❑ PLUMBING rl SIGN <br /> PROJECT ADDRE88 <br /> �3� �K� v�. gv�ie�-r 8'a� � <br /> OWNEq MAIL/i00RE55 q7Y 21P P110NE <br /> ��GL�� 1731 �:'�CKh2 A�� �J'erC'tst�r q8201 ZS''7- r�� <br /> 7eWWT MMLADORE55 Cltt 21P PHONE <br /> MCMTECTOROESIGNER MAILADDf1E55 Cltt 2�P PHONE <br /> 6ENEpKCp�TMCTpp �,W��pppE$$ CI1V ZIP PHONE STALEUCENSE� <br /> MECXANIC/�LCONIMCTOfl MNlAUd1E55 CITY ZIP PNONEp� SiATEUCENSE� <br /> o.�er n� � �cc .��rin �/ �i F AnaOiNF el Ftw1 i� Fi/�'lQL�A' (azG� £t�"-.311'F F✓�SIZfK7 <br /> �'��G CITV ZIP PHONE ST�TEIICENSE� <br /> RUMBkqCONTRACTOfI M�ILAODRE55 <br /> �T��"s°p` HEATING SYSTEM: �GAS ❑ELECTRIC f_l <br /> pESCqlEW.7111(AHDSOUAREW0TIIGEINVOWEO CONT�CTVEPSONNlOPHONE1q. �y �����// <br /> �a lA A" <br /> c M Pc�fE — ,� � <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> �� P� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> ��u����� PROVISIONS OF LAWS AND ORDINANCES GOVERN�NCa THIS TYPE OF <br /> �I ��N7�Ih�— WORK WILL BE COMPLIED WITH NMETMER SPECIFIED HEREIN OR . <br /> ��(L1�p�5C,qIPfpNpFp�ppEpry�S�pyyllgE�pWIXiATfACN7WOCOPIES) p�pT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi xoac oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL UW REQULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM 11UTMORIZED BY THE <br /> OWNER OF TMIS PROPERTY TO PERFORM THE WORK FOR WMICH <br /> APPLICATION IS MADE AND I COMPLY WITM TME STATE <br /> CONTRACTORS UW 1827 RCW AND 298R00 WAC. <br /> FAHCELiNf I.D.MNMEP / ��f�� <br /> CONSIMIC710NldWLENOER.A0d1E6S.TElEP110NENlA1lEP /r,�— / � J ✓ / �� I�—�' " � <br /> 'S�`c��ATUPE WTE <br /> qry BUSINE55 LICENSE N0. <br /> ���� MECMANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF FIXTURE ON ITEM FEE <br /> WATER CLOSET(TOILEn � NC—MiNDLO UNITS—H.P. ' <br /> �TM� � FORCEDAIRSVSTEMS—B.LU. �G� ' <br /> UVATORV ASH BASIN) � HEAT PUMP ' <br /> g��R � UNITHEATERS—B.T.U. M � <br /> KRCNEN&INK 8 DISP i CLOTHES DRVERS � <br /> DIBHWASMER � VENTILATION FAN ' <br /> LAUNDRY TAAI ; RAN6E HOOD � <br /> CLOTHES WASMER � WATER HEATER ' <br /> URINAL <br /> � WOOD STOVE � <br /> DRINKIN6 FOUNTAIN � METAL FlREPLACE(WOOD BURNING) � <br /> FLOOR DRIUN � FIREPUCE INSERT(WOOD BURNIN6) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � OAS RAN�E ' <br /> � GAS PIPINO <br /> , E%HAUSTFAN ' <br /> � <br /> � <br /> � <br /> � � <br /> SUB TOTAL f ' SUB TOTAL E � _ <br /> PERMIT S � PERMIT 5 � <br /> TOTALFEE E � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> pqpH7�79/�q( qE/�q$EiB/�LK SIOE 6ETBACK PUN CHEC NUMBEP FEE RECEIPT NO. <br /> uSEiq+e io7�nE� V�C�NTSITE FE VIILUATION FEE <br /> ❑ves n ra � <br /> BUILDINO � <br /> MEIONTUMTATKIN NOOFOWEWNG SREOFBLIXYfI. i <br /> UNITS PLUMBMO � <br /> OCCUPANCY Iq.0i610NE5 �CCUPiWTLO�D B�SEMENT MECH�NICAL i <br /> aROIIP � <br /> ❑YES ❑ PNI i . <br /> ADDIT10NAl PLAN CHECK _� <br /> FIRE/�IMM REOD REASON <br /> . � <br /> OTHER � <br /> FIRESPNIMQERREO'D PE�SON � <br /> STATE BUIL�ING SURCHARGE � <br /> TVPEOFCONSL PUNSMPROVEOBY CITYOFEVEHETT PUBUCWORKS � <br /> LOCAL SALES � <br /> o�re TAX CO�E IS 3105 TOTAL ' <br />