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APPLICATIO:� FOR CONSTRUCT�JN PERMIT <br /> CITY Of EVERETf•BUILDING DIVISION V <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •: �9-8810 <br /> ❑ DEMOLITION ❑ COMBINATIO� �BUILD:iVG ❑ IuIECHANICAL ❑ PLUAABING ❑ SIGN <br /> PROJECT ADDRESS: `�� �}�\;�S�" �� <br /> /�L 5�7���. s �. ��,�-� ��'�Zo3 <br /> OVMEN MNll10d1E55 �IiY tip E <br /> �� � �l./ �/ / <br /> TENNiT WI1�00{I[55 GItY jIV PIqNE <br /> �` o�^%f`lF-JZ <br /> 11RLMTECTORDESIGHEH MM11100RE55 CIfV )IP PNOHF <br /> GENEANGONTRnGTOq M�IL110011E55 �IfY 7iP PnONE SI�TEtICCNSE• <br /> MECMAMCqtONTR��TOR MMlA0p1E55 GTY 71P PIIONE Si1TEl�CENSC� <br /> PlUA1BING CONTR�CTOR MAIL�DORESS CITY tlP :'NpNE $T�TE IICENSE• <br /> Cd/TMLTPp�CE0iWq11c G� <br /> HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> OESGfMlE NOf11(AND SOUMiE FOOT/iCE 1N v cor+uci rensow►ru c�rro <br /> �9B Csw�r�iT �Sa�1{{C <br /> _� S��A-!'e< <br /> /' � I HEHEBV CERTIFY THAT 1 HAVE READ AND E)(AMINEO THIS <br /> ^ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnoaoseo�se or mmar+o PROVISIONS OF UWS AND ORDINANCES GOVERNING TNIS 7VPE l� <br /> WORK WILL BE COMPLIEG WITH WIiETHER SPEdFIEU HEREIN OR <br /> LEMlOESGiMPT10NOFiM10PERTY�51pNRIBEIpWpqAnilGM7NqCOPiES� NpT. THE 6RAN?IN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT e�ocK oa AUTHORITY TO VIOUTE GR C!`1tEL THE PROViSION f F ANV <br /> OTHER STATE OR LOCAL LAW RE6UUi iN(i CIMISTRUCTION JH THE <br /> PERFORMANCE OF CONSTHUCiION.THAT 1 AM AUTHORIZED BY THE <br /> ONMER OF THIS PROPERTV TO PERFORM TH:= WORK FOI WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> wwce�t i.o.r�m�eEn — CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> . . CONSTIIIICTIONLOMiLENDf�.�Op1ESS.TELEPNONEMIMlER X <br /> ' � -3-4Co <br /> 510 RE / D�7E <br /> ' CItY�SIICENSE NO <br /> ���M� MECM�NICAL <br /> NO. TYVE OF FlXTURE OH ITEM FEE NO. TYPE OF EpU1PMENT FEE <br /> WATER ClOSET(TOILET) � NC—AMNp�p UNfTS <br /> BATHTUB ; FORCED AIR SYSTEMS ; <br /> UVATORV pNASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATLHS � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS ; <br /> OISHWASHER � RANGE HOOD � <br /> UUNDRY TRAV ; WATER HEATER ' <br /> � <br /> CIOTNES WASHER � WOODSTOVE � <br /> URINAL � METAL FIREPUICE(WOOD BURP'ING� <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN � GAS FIREPIACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> E%HAUST FAN <br /> i <br /> i � <br /> i � <br /> i � <br /> SUB TOTAL S � SUB TOTAL S ; <br /> PERMIT f � PERNIT f � <br /> TOTALFEE f � TOTAiFEE f ; <br /> FOR OFFICE USE ONLY: <br /> /qONTSETR�CK RE�RSETB�LN SIDtSETB�Ck PUNCIIEC1tNUMflfR fEF �Ff.fIP�NO <br /> USE 20NE l0T�PE� VAC�NT SIfE FEES VALUATION FEE <br /> ❑YES ❑ NO BUIIDM6 2G i <br /> HEIGNTUMIT�TION NOOFOWEIIING SREOFBLOGRI <br /> UHIfS P��JM61NG i <br /> _ � <br /> 6�PANCY 1qM5f(sbFS OCCUP�NiIpW B�SEMENf MECNeNIG�L ' <br /> ❑YES ❑ NO — —' i <br /> FIRESPPINKLERPEO'D �FASDN �OD1110N�I.PUNC��fGN � <br /> T� <br /> 01HEn <br /> FIREAlAR1ARE0'D PE�C(„1 q <br /> SI�lE0UM1O1Nf.511f1C1UpGE — � ,:�j // <br /> .�y. <br /> trre ov r.or+sT ninNs nnrnovFn er CITV OF EVERETT runi ir,woaKs <br /> LOCALSALES — -— <br /> o�iE TAX CODE IS 3105 TOTAL � � � <br />