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APPLICATIO.� FOR CONSTRUCT►JN PERMIT <br /> CI'i Y OF EVERETT•BUILDING DIVISION �CM��� <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION I�] COMBINATION ❑ BUILDING ❑ AAECHANICAL � PLUMBING ❑ SIGN <br /> pROJECT ADDRESS: �� , r1 � <br /> ��:ln (v.�rd'wcl+� ���T 1�a � �.E� vvC`� 1J3 �c �9� / /Z <br /> MML�OOFE55 Cltt 21P PNCN[ <br /> 7EWiNT <br /> MNI�Dd�E�s GTY I�P FNONE <br /> /�pLMTELT0110E51f.NER 1MIlMp�E55 <br /> p�ry lIP PHONE <br /> —iiGi F�T2 Cc 5tfucfiun �O/S tt rrt✓ �u� FUerlf i ,ra c�1U� ,�CLo E`.d /S6L �iE cRNs�n� � 3G <br /> GFNEiUIGOMTR�tr01 wutl�W11E55 —-� ctv 1�r <br /> yECNNlIC/�LCONTRACTOR MMIADONE55 <br /> f.ltt Z�P PMONE STATE UCENSE� <br /> ��n. zry P1qNE STRELICENSE• <br /> p�UylMiG�pNIP�CTOi: MIUL�Dd�E55 <br /> �TR"�T�OF"°"" HEATING SYSTEM: ❑GAS ❑ ELECTRIC O _ <br /> cor+ucr veasa+u+o v�oi+E r+o 3/7 <br /> OEShcEN'pVl11NO50UM1EFO0TAGEINVOIVED p � r< - <br /> Q � I � L <br /> � I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> e� ra t =SU�+ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �pp�p�pF onq PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> S� C M i I S WORK WILI BE COMPLIED WITH WHETHER SPECIPIED HEREIN OR <br /> � �� a�p «���� S`���,r�s, AUTHORITO TOTVIOLATEAOR CANCE ETHE PROVISION OF AINY <br /> i.0i 3 �� � OTHER STATE OR LOCAL LAW REGUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTIIOFiIZEO BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br /> APPLICATIO IS MADE AND I COMPLY WITH THE STATE <br /> . CANTRACT 5 W 1827 RCW AND 296200 WAC. <br /> pNILEI Th1I 1 D.MIGIEEN <br /> x � �" - % 7 <br /> � �57pUCTIONLWNIE R.MId,�1E55)7E1ER10HEMWBER 11TURE D�IE <br /> �-N h n l.tlG9� �"�'r(�4"P <br /> CITY BU5��5$LICENSE NO <br /> ��� MECHANICAL — <br /> FEE NO. TYPE OF EGUIPMENT FE�_ <br /> NO. TYPE OF FlI(TURE OR ITEM � NC—AMNDIG UNITS � <br /> WATER CLOSET(TOILET) <br /> BATHTUB ; � FORCE�J AIR SVSTEMS � <br /> LAVATORV(WASH BASIN? � HEAT PUMP ' — <br /> � UNIT NEATERS � <br /> SHOYIEFi , � <br /> KRCHEN SINK 8 DISP � CLOTHES DRVERS <br /> � / RANGEHOOD � <br /> qSHWASHER / ' <br /> � WATER HEA7ER ' <br /> LAUNDRY TRAY ' <br /> � WOOD STOVE ' <br /> CIOTMES WASHER � METAL FIRtPLACE(WOOD BURNING) ' <br /> URINAL FIREPLACE INSERT 1W0�0 BURNING) � <br /> DRINICINCi FOUNTAIN � GAS fIREPLACE � <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GASRMIGE ' <br /> SINK(SERVICE--BAR,ETC.1 3 GAS PIPING � <br /> IXHAUST FAN � <br /> � <br /> � � <br /> i <br /> i <br /> � <br /> � SUBTOTAL : <br /> SUBTOTAL f � PERMIT S <br /> PERMIT S � <br /> TOTALFEE S � TOThLFEE S <br /> FOR OFFICE USE ONLY: ner.eirT Ne <br /> _`�T��� ���T�N SIOESETO�CK <br /> Pl�NG11ECNNUMHfR ��� �� <br /> �J..J�S �'` <br /> � FEES VALUATION F� <br /> �U�zppp��� OT�RE� VI�C�NI S �- <br /> _ / ❑YES ❑ � BWIDINC �'��J _�� , 30 <br /> HEIGNT U4ITATI NO O�UMIE�UN6 S�SE Oi'BlIX'+rt� �� � <br /> uNns 'L`JJ N3 S.f, ri�,unrt+c _ ��-- <br /> p��CU�NGY Iq(K$IMbES OCCIIP�NT IO�U 8� �NT / MECIUNICAI __ __�7O '__ <br /> Z ❑YES LYNO � <br /> K_ U- �DDIIION�I.PI�N G�EGN <br /> T— <br /> FlNESPHINNLEPREO'D RF�SON <br /> 0111ER ----���/� <br /> FlREAWIMREO'A RE�c� '__ y ;�(/ <br /> SiAIE flUIIUWC S���CN41GE <br /> . — �/�� <br /> TYPEO�f,pNST PL�NS�PPAOVEDBY CITYOFEVERETT rueiicwonKs _ _4_S/'_ <br /> LOCALSALES <br /> Y— or,rE 9 TA%CODE IS 3105 ToiAL <br />