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,-_. <br /> APPLICATII A FOR CONSTRUCti _aN PERMIT <br /> CITY OF EVERETT•BUILOING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION � BUILDINO �AAECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS: �(_Tr21lLK1.�2 E�� ' �SZ•�) I <br /> pW��q � uulwoiEss arv nr rHOME C <br /> � � � 1 �? r _) � <br /> G <br /> T �OORF.55 Cliv TiP 14�ONE <br /> / <br /> �RCWIEGTd10E51GNFR MAh E55 CITY l�� �NONE <br /> GE �;�yCONi;�ylOR MIJLIIWRE55 CrtY S�P l P�qNE ���TEUCENSf• <br /> ��Yu W R'��1�� �ZcY� �(!�c��-�k� � , I,�A �%1� � �_T?� L�1-ILa�t: <br /> CN�NIGILCONTMCTOR NNlA00NE55 ^ CItt ZV` PIIONE S7�iEL1 N.,E� <br /> �A,,.�c �s�a.-4�0 0 <br /> PlUA6MG COMTR�CfOR M��l 55 CIfV IIP P1qNE ST�TE IICENSE• <br /> / <br /> �°"T"r�cT°wc�°` � IIEATING SYSTEM: AS ❑ EIECTRIC � <br /> pEg�p�lE WpIK Mq 11RE FOOT/i0E MVOIVED GONT�GT PEPSON�ND PIqHE N0 I � .i <br /> L <br /> �R�--'��G Li <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLI�ATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnovoseo use or auaa�+a PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ��o�sc�Pnwp�viqvEnrr�gqvmeE�owov�n�cNTwocoa�es� NOT. THE ORANTING OF A PERMIT DOES NOt PRESUME TO 61VE <br /> �or eiocK ov AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STA1E OR LOCAL LAW RE6UUTINCi CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.TNl1T I AM AUTHORIZED BY THE <br /> — OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS A0£'AND 1 COMPLY WITH TNE STATE <br /> CONTRACTOR 18.27 6.200 WAC. <br /> PAqCELTN(I.D.M1GlER // <br /> �5 l lENOER. E55.TELEPNONE MIMSEP X " ��� � v <br /> SMN�TURE D�TE <br /> Cltt BVSINESS IICENS[NO <br /> ��y MECNANICAL <br /> Np, TYPE OF FlXiURE OR iTEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIEn � A/C—AMNDLG UNITS ' <br /> � ��UB � FORCED AIR SYSTEMS i <br /> UWATORY(WASH BASIN) � HEAT PUMP ' <br /> SHOWER ' UNITHEA7ERS ' <br /> KITCHEN SINK 8 DISP � CLOTHES DAVERS � <br /> DISHWASHER � RANGEHOOD ' <br /> UUNDRY TRAY ' WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKINCi FOUNTAIN � FIREPLAG�:NSEF7T(WOOD BURNING) � <br /> FLOOR DRAIN GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> � IXHAUSTFAN <br /> � <br /> i <br /> i � <br /> SUB TOTAL S SUB TOTAL f i <br /> PERMIT S � PERMIT S <br /> TOTALFEE f ' TOTALFEE f <br /> FOR OFFICE USE ONLY: <br /> Ff10NT SETp6CK AE�R SF.TB�LN S�DE SETBACN PUN C��ECN NUMIIFN (EF REf.EIPI NO <br /> �3�7a1_n <br /> USESOME IOi�HE� V�GANf$IIE FEES VALUATION FEE <br /> ❑YE$ ❑NO ppiLOMC <br /> HEIONi LIMITATION MO 0�OWEIIING SIZE OF BIOGRI <br /> UN11G P�IIMOING <br /> T <br /> OCCUP�NC� MOl%S�MMCS OGLUP�Nfl0�0 B�SEMENI MECN�WCM <br /> GROIIP <br /> ❑YES ❑Nn <br /> •DDIIIONAt 1'UN GIfGK ' <br /> FIRESPRINKLERREO'0 AF�S� �— <br /> 01MER <br /> FIREAIMMREO'D AE��ON <br /> ST�1E flU11MNG SIInCIU�GE <br /> rrvear,or+sr ninr�serrnovcner CITYOFEVERETT ruqnr,wonKs <br /> LOCALSALES — — <br /> u��E TAX CODE IS 9105 TOiRL <br />