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APPLICATIt��I FOR CONSTRUCI �ON P�RMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8810 <br /> I-1 DEMOUTION �1 CQMBINATION f� BUILDING �`l� MECHANICAL � 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS 1- <br /> J C'%Z ���U!CKJ (�JP ✓ <br /> OWNER M�IIGOfI.'c5s p7y zir rr�oNr <br /> CGJ,E'6� /v�S��S �'�Z SF���F., wa✓ FvbF��rr `)8ZG'h �55 � S?O� <br /> 1EH11NT M�ILNDL*�E55 CIfY 71P {`�IONE <br /> ARGPoTEGT 01i OESIGNEF MMI.�DpRE55 GIiY ]IP PHONf <br /> f,ENEfUICONTR�C70R MMl11DDP[SS Qlv ]�P P��pNf $TQ[IICENSF� <br /> ME�CjH�NI����ONTR�CTOfI M�II�DDRF.55 Q1V ]9 NIONG Si�TE11LFN5E� <br /> G=�1 <br /> PWMBINGLONTH�CTOR MAII�DDRE55 CITY im P110NE STntELICENSE� <br /> �TMCT PRICE Of NV11K <br /> �}p.a� HEATING SYSTEM: �GAS f l ELECTRIC f� <br /> ,�CRIB! pRNANOSW�RE,`OOTAGEINVOLVE� CONi�CT�FR50N�NDP110NF.N0 �" �/ <br /> ` � c� �oa Cb0 /'TG( itJ�?�T/.�F�1 G �c'c` Z5Z -.�/�f <br /> � • e RN � ,A� f(� <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnocose�oovse ov nimonic PROVISIONS OF LAWS ANJ ORDINANCES GOVERNING THIS TVPE OF <br /> SF^ WORK WILL BE COMPLIED WITH WHETHEF 5?ECIFIED HEHEIW (�i <br /> LEWLOESCRIPTIONOFFqOPEPTY�51qWNBEIOWORATi�LNTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br /> tor e�ocu_ or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO 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 MADE AND I COMPLY WITH THE STATE <br /> v�ace�r�x i.o.m»�aen CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRIICiION 1011N LENOER,�UpiE55.TElEP110NE MMBF.P ��,_/. ` (r�� �G -/ /,�J <br /> SIG �TURE O�TE <br /> dTY BUSINF.SS IICENS[N0. <br /> PLUMSINO MECHANICAL <br /> NO. TYPE OF FlICTURE OR ITEM FEE NO. TYPE OF EpUIPMENT FEE <br /> � WATERCLOSET(TOILEn � A/C—AMNDLOUNRS—H.P. ' <br /> BATNTUB � � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) HEAT PUMP � <br /> SHOWER � UNIT HEATEPS—B.T.U. M ' <br /> KITCHEN SINK 6 DISP ; CLOTHES ORVERS � <br /> DISHWASHER � VENTILATION FAN <br /> LAUNDRYTRAV ; RANGEHOOD � <br /> CLOTHES WASHER WATER HEATER <br /> URINAL ' WOOD STOVE <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR ilRAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) GAS RANGE <br /> ' GAS PIPING ' <br /> � EXHAUSTFAN � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ I ; <br /> PERMIT $ PERMIT S I5 � <br /> TOTAL FEE S ' TOTAL FEE S ,�"r'' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETp�C1( PE�R SFTB�CN SIDE SETP�CN PI�N CIIECK NUMAfR PEF RECFIPT NO <br /> use ioNE iot�aen vec�r+r stF FEES VALUATION FEE _ <br /> IIYES fl NO � <br /> _ FlUILDINf. <br /> NEIGNTLIMITATION NOOFOWF.LIING 512EOfALIX'i�fl 1 - <br /> UN17$ Pl11MOiN a � <br /> � <br /> OCGUPANCY NO 0�5�(��(5 OCCUPANI LO�D B115FMENI MFCIIANiLRL � <br /> GRWP � <br /> f1VES IINO <br /> FlRE�IARM REO'L1 11fA50K RDOI110NRI.PI AN CHf f.N <br /> �— <br /> omcn ; <br /> FIRFSPf11NItlFRtiF.O�� RF�S(k1 <br /> SLNE OUII�IYf,SUf1CNMGE � <br /> i <br /> ivreorr,ovsi rinNs�ronoveoav CITVOFEVERETT rumir.wonKv <br /> LOCAL SALES — --- --- <br /> o�TE TAX CODE IS 3105 TOTAL _ <br />