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APPLICATIL_�1 FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8870 <br /> ❑ DEMOLITION O COMBINATION B'BUIIDING O MECHANICAL p PLUMBIN(i ❑ SION <br /> PR ECT ADDRES : <br /> � � <br /> R u 55 c�i'I 2m P1qN[ -- <br /> er a o - g�_ <br /> �p� MNLIIDORE55 QTY 71C 1'110NE <br /> �a c i�;r NE�ar�i�555 (�i t��e 1�i�►' fv,e.�'�etf 9b'�vl�F �S�- l31/ <br /> GEr/Enucowrnettw u woaEss crtv tm mwr�[ SI�TEIIC[NSE• <br /> yEpUHIC/�IGpNTp�CipR MAIIADOHE55 f.ITY ZII` P110NE ST1TEl�GEN$E• <br /> PIUheMK.CONTR�CTOR M�IlAOdiESS ��n" ZIP PNONE ST�tELKENSE� <br /> co�r�ucTr�aw«m / 7 Z 9 HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> p1p�.�..� ARE FOOTbE MVOLVEO CONTICT O[RSON�HD PMOHE NO <br /> I HERE9Y CERTIFY THAT I HAVE READ AND EXAMINED TMIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ����aM� PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TVPE Of <br /> WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br /> IEp�LpE$LpPIqNpFPIqPEq7Y'��5l7IO�W7pBELOWORATT�LN1YqGONES� NOT. THE ORANTINCi OF A PERMIT DOES NOT PRESUME TO dIVE <br /> �oi � �� eioac_L oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTMORIZED BV?HE <br /> �1�!r7 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> -T.J /�-� 7* 7- DI � -DOD� APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> MRCFLT/J(��MMlER CONTRACTOHS LAW 1827 RCW ANU 296200 WAC. <br /> CpI5TiN1CT10N ldW IENOER,I1001iE55.TEIERqNE MIMEER X I\ �� A�-w�'1/Y/ /L - <br /> SIGN�TURE �T�/�� <br /> Cltt BUSINESS IICENS[NO <br /> p�,�p MECHANICAL <br /> NO. TVPE OF FlI(TURE 011 ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C-AMNDLG UNRS ' <br /> BA7�{7�g ; FORCEDAIRSYSfEMS ; <br /> UVATORV(WASH BASIN) � HEAT PUMP � <br /> gj.pyyEq � UNIT HEATERS ' <br /> KRCHEN SINK 6 DISP i CLOTHES DRVERS i <br /> DISHWASHER RANGE HO00 ' <br /> U:INDRY TRAY ' WAT�R HEATER ' <br /> CIOTMES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRIkKINCi FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> �ppq pp��µ GAS FIREPIACE ' _ <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE-BAR,ETC.} GAS PIPING � <br /> IXHAUST FAN <br /> i <br /> � � <br /> i <br /> � <br /> SUBTOTAL f � SU�TOTAI S � <br /> PERMIT f � PERMIT f <br /> TOTALFEE f TOTALFEE f ' <br /> FOR OFFICE USE ONLY: <br /> FRdR SE79ALN � PEAR SF.TB�LN $IOC SFTB�C/ M�N CIIECN NOMfl[R �Ff � /0 p«Fi��MO <br /> Zo � , � ro <br /> ��¢p� l01�REA VAC�NI SITE FEES V�LUAiION FEE <br /> _"3t ❑res �a eunnwr, '60 <br /> IIEIGNT UMTIITION ' NO t�DN'ELUNG SI2E OL BLDGR� � � <br /> i <br /> � �� PIUMpING i V�J <br /> OCCUP�NCY NO(%SIdb6 OLCUP�M LO�D B�SEMENT MECN�NICM <br /> anour � <br /> V� ❑YES ❑NO ; <br /> FlRESPPINKLENREO'U RF�SON �DDIIION�LI'I�NG�lLK <br /> �-- <br /> 0111Ef1 <br /> FIREALAIIMPEO'� AE�SOM <br /> StelF BUII�MO SURCII�f10C �JQ <br /> TYPEOFf,ONST PLAHSAPPAOVEOPY CITYOFEVERETT �IiNlif,wURrcS -^� <br /> � J � LOCAL SAIES — —'— <br /> �� o.,e 3 Z�r 9G TAl(CODE IS 3105 TQTAL /� � J <br />