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APPLICATI�.N FOR CONSTRUC'r .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> p DEMOUTION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> pROJECTAODRESS: /�'7.�J �UG�-'P.1L- Av� <br /> EK/�ti YE�-c.0 <br /> OYY1iER 4IULMIX1E55 Q7Y 21P FHONE <br /> Ssas� ��.s-� s7'S�✓ i.-��T wA 9���.� ����fQ�"� <br /> TE/NNT �y MNl/i00RE55 G�� IIP P��OME <br /> �C/v`. <br /> MLNRECTOROESN'✓1ER AW1b011E55 Cltt 71P �NONE <br /> SArn-� <br /> pENEMIfANipACTOR MIJLI100f1E55 GTY lif• f�IONE �t�TEIICENSE� <br /> MEp1ANICALfpN��CTOR MMl�00RE55 CATY IIi' 0110NE STFtEL�CENSE� <br /> PLU4eMCCONTR�CTOR M�ILI�WRE55 CItV 21P PNONE $T�TELILENSE/ <br /> CONTR""PR1�°P"p"" $ L��j U U�/ HEATING SVSTEM: �GAS ❑ ELECTRIC ❑ <br /> pE�Wpilt Mq$qJI1f1E FOOT�GE MVOLVED CONTACT pER5p1 Alq PHONE NO <br /> _ ` <br /> %G T/�L ILPM G�OA L /,y OD ,.$_ '7 — Q 7 <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT ALL <br /> rnorose0 usE oF eu�a.xi � /G�e PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> /l� WORK WILL BE CAMPLIED WITH WHETHER SPECIFIE� HEREIN OR <br /> �pEsc�wrqNprpiqv¢nrr�yqwneE�owoaA I�GNIwOCORE L NOT. THE ORANTINO OF A PERMIT DCES NOT PRESUME TO GIVE <br /> �QT��µpp� '.3�7 pF � � � J'� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGUUTIN(3 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAOE 11ND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br /> PNCEL T/U(I.D. R <br /> ' • 3 oia � �z�Z 3��/� <br /> CONSTfRIG7I0NlONIIENUER.MpiE55.TE1ER10MEMMBER x � <br /> O N SN3N�T D�TE <br /> CITY BUSINE55 LICENSE NO <br /> ��np MECNANICAL <br /> NO. TYPE OF Fl%7URE OR tTEM FEE NO. TYPE OF EOUIPMENT FEE <br /> / WATER CLOSET(TOILEn � NC—IVMNDIfi UNfTS ' <br /> BATMTUB � FORCEDAIHSYSTEMS i <br /> / LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SFIOWER ' UNITHEATERS ' <br /> KRCHEN SINK 8 DISP ; / CLOTHES DRYERS � <br /> DISHWASHER � / RANGE HOOD ' <br /> UUNDRY TRAY � WATER HEATER � <br /> / CIOTHES WASHER � WOOD STOVE ' <br /> URINAL ' MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKIN(i FOUNTAIN i FIREPIACE INSERT(WOOD BURNING) i <br /> ROOR DRAIN GAS FIREPLACE ' <br /> BACKROW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> IXHAUST FAN <br /> i ' <br /> i � <br /> � <br /> i � <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMIT S � <br /> TOTALFEE S ' TOTALFEE 5 <br /> FOR OFFICE USE ONLY: *��2� � �Q��� � � <br /> �qppT5E7p�Cg REARSFTB�CK SIDESETB�CK �UNCIIECNNUMfl[R fEf �7 RECEIPI � <br /> o Zv � S ' rpgLcO ��l ��,� <br /> use z im eeee vecu+r srte FEES VAIUATION FEE <br /> �.—�1-` 5000 ❑rEs r+o ' <br /> aonrnr+o Z v ; <br /> 11EIGHT LIMITIITIJN � NO OF UM'EILING 512E OF BLI16R I ���� � <br /> -�s uNits � L� SF p/7o�1 P�pMBING _�'1/; <br /> =t— <br /> ��N(:V NO(1�S��ES OLCUP�NI LO�U BASEMENT �/ MFCM�NiC�I 3 r� ; <br /> yJ'3 -L- ❑vE5 �M� � <br /> ��• �DD�IIONq.PUN CHfGM <br /> FIRESPHINKLERPEO'D �fA50N —�- <br /> O1HE� <br /> FIflE�MPEO'O AE�SOH — � �/� <br /> SiAIE BUiIOMG SIIRCN�RG[ "��� <br /> rvvEorr.or+sr rinNs�rrnovn r CITYOFEVERETT r�ia�ir,vronK� y <br /> LOCAL SALES — �� <br /> ��� o�TE � (rj TAX CODE IS 3105 TOTAL 7 <br />