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APPLICATILA FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> fl IDEMOLITION fl COMBINATION (-1 BUILDING f� MECHA►tICAL �k( PLUMBING f l SIGN <br /> PROJECTADDRESS �qt� ����. �V� ,EV�G` 1^ <br /> l <br /> �ER MNL�ODRE55 Cltt LP P110NE <br /> ���e.hv..( l� 1�1�z.R�u�}� ���'7`' 4£r�� 1 33q 3668 <br /> IENANT MRII.�DDPF55 f.ITY 71P PHONE <br /> �ne� <br /> �RCNITF.CT OR DESIGNER M�II.�O�NESS Cltt llf PMONF <br /> �wn� <br /> GENEPAI CONIMQqi M�IL ADDRE55 ❑iV )�P t'110N[ SIATE LILENSF� <br /> �W n E� <br /> MELH�NICRL CONTPnCTOR MRII AD[ME55 [Itt 71P PIIONF. ST4iE LICENSE� <br /> Q L✓s� <ir <br /> PWMBINGCONiR�f.TOR MMIpDORESS CIIY ZIP PHONE $TAlF.1.IGFNSE� <br /> ��L✓ 7l C/Ir <br /> WNTR�Ct PRICE OF WORN <br /> , HEATING SYSTEM: I l G,�S DdELECTRIC f I <br /> DESCRIBE N'fMN�ND WUAPE FOOT�GE ILNVOLVEU CONT�CT 1'FRp�`!PNO CHpNE Np � 3 3 9 �o � <br /> /�OJ�1 ✓ .• M GAl1Gu <br /> �ai/� 7�o P�Xis fn� �Qr�r�cQiy ✓'DOm. <br /> I HEREBY ;ERTIFY THAT 1 HAVE READ AND EX.4MINE0 THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROPOSED USE OF BUIldN6 PROViSIONS OF IAWS AND ORDINANCES GOVEPNING THIS TVPE OF <br /> WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Ofi <br /> LEGALDESGMPTIONOiPf10PEPttI5110WNBELOWdi�tt�CHTWOCOPIES� NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> iot BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR�.00AL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEP OF THIS PROPERTY TO PERFORM THE WORK FOR WIiICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PWf.EL U%IA.NVMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUGTION IO�N LENDER,�ODi1E55.1ELEPHONE NUMPER /(��//"'�`^- �� fl�/��5� <br /> 81GI�TURE O�TE <br /> CITY BUSINE55 UCENSE NO <br /> PLUTAe1N0 MECNANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOIIET) � A/C—AMNDLGUNfTS—H.P. ' <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS—B.T.U. M ' <br /> KITCHEN SINK 8 DISP i (:LOTHES ORYERS __ <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRY TR.G1' � RANCaE HOOD i <br /> CLOTHES WASHER WATER HEATER � <br /> URINAL WOOD STOVE <br /> DRINhING FOUNTAIN METAL FIREPIACE(WOOD BURNING) <br /> FLOOP.DRAIN � FIREPLACE INSERT(WOOD BURNING) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAH,ETC.) � GAS RANGE _ <br /> GAS PIPING <br /> i EXHAUSTFAN � <br /> i <br /> i ' <br /> SUB TOTAL S ..� � SU9 TOTAL $ i_ <br /> PERMIT $ y0 � PEPMIT 5 � <br /> TOTALFEE E TOTALFEE $ ' <br /> FOR OFFICE USE ONIY: <br /> fRONTSFTPRCK PERPSFTP�CN o�DESETAAGk �IqNL11ECkNUMflfR �[f R[CFIPTND <br /> �l�p ' ''- <br /> use zowe IOT�PE� vacnra sire FEES VAlUAT10N FEE <br /> � <br /> iires rNo ouurnr+r, ' <br /> NE�GNTUMIT�TION MOOFDWELLING SIZEO�PlIXi41 - <br /> IINIIS PIUMflING � <br /> I <br /> OCCUPANGY N6[K 90AIE5 OCCUP�NI t0A0 BRSEMENT MFCH�NICAL � <br /> enour _ <br /> IlYFS II NO — <br /> fIREMARMRF.O'D RGRSON AOO1110NMPIANCH(CN - � <br /> �T <br /> O111fR <br /> IIRE SPRINRIFR REO�p RFRSON <br /> STNL 111111DING SIIRGIIARCE <br /> rvrForcorus r�nNsnrrnovener CITYOFEVERETT rurnc�^mnrs <br /> LOCALSALES ---- — - -- <br /> �q�E TAX CODE iS 3105 TOTAL__ <br />