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r <br /> APPLICATIO.. FOR CONSTRUCT► JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,Wq ggp01 �259-8810 <br /> � ���1� ❑ COMBINATION p BUILDING O AAECHANICAL ❑ PLUAABIN(i ❑ SIGN <br /> PROJECT ADDRESS= X J ��Z S U/�w Wfiy ��/�7T <br /> �'�/�ulD ��4.t1C� 78// S�E 2 7 �_' ST S/� /9b u�f}98o4a �?�6 Z86-S�L <br /> OYIIIER MiUlMIX1E55 GTV I�n �,1 p�E • <br /> r�1n.�r4.� L� <br /> 1ENN1T uMl�00R[55 div )In PiWUE <br /> MCMT[CTORUESIGNER Mn11�D011E55 Clfv ln' �NOHE <br /> OEMEMICOMiMCTO11 MML�JDIIE55 �IfY 7if' fhpNE Sf�TE110EN5E� <br /> k r-�5�� ��sr. 1��1.�3-�z�� l�� �,�����o,��y/ <br /> CM�M�C�LCANTIUCTpI MIu1�0011E5S GiY ZIP � FI1pNE ST�fEUGENSE� ' <br /> %UMMMGCONTRII�TOR MIUL1100PE55 CIfY IIP PNp11E $T�IELIGEN$E� <br /> CONTMCT pi <br /> J'��A �-� HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> OE • SOUM1Ei00TAOEMVOlVEO Cp11�CTOCR50N11NDP1qNEN0 <br /> I HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED THIS <br /> mOroxo usc or eim.dra C � APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL <br /> J PROVISIONS OF UWS AND ORDINANCES GOVERNING TNIS TVPE OF <br /> WORK WILL BE COMPlIEO WITH WHETHER SPECIFIED HEREIN OR <br /> �wo�scwvna�a°no°Emr�s�aw"°E�°�"°n"n"�"�woco�Es� NOT. THE ORANTiNO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> �oT �� a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REODUTiN(i CONSTqUCTpN pq 7HE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNOqIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM TNE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIV WITH THE STATE <br /> ►wett r��o.ra�,w¢q CTORS UW t .27 q�200 WAC. <br /> OOMSTRIIGIION ldW IfNUEH.Md�E55.iELEPIqHE MIMSEII �� <br /> SqN�TUHE D�TE <br /> C�1Y BUSINE55 t�CENSE Np <br /> ��� MECHANICAL <br /> . N0. T1TE OF FlXTURE OR ITEM FEE NO. fYPE OF EOUIPMBlIT FEE <br /> WATER CLOSET(TOILET) � �_�N��� <br /> &1THTUB ; FORCED AIR SYSTEMS � <br /> � <br /> UVATORY(WASH BASIN) i HEAT PUMP , <br /> S��p ' UNIT HEATERS � <br /> KITp1EN SINK 6 DISP i CLOTHES DRYERS � <br /> OISHWASMER � HANGE HOOD , <br /> LAVNDRY TRAV ; WATER HEATER � <br /> CIOT}IES WASHER � WOOD STOVE � <br /> URINAL � MEfAL FIREPIACE(VJOOD BURN�NG) � <br /> DRINKINO Fq1NTAIN � FIREPLACE INSERT(WOOD BURNING) ; <br /> ROOR ORAIN � GAS FIREPLACE � <br /> BACKROW PREVENTERS ; GAS RqNGE � <br /> SINK(SERVICE—BAR.ETC.) GAS PIPING � <br /> EXHAUST FAN <br /> i � <br /> � <br /> i � <br /> i <br /> SUB TOTAL S � SUB TOTAL f U ` <br /> PERMIT f PERMIT f / ' <br /> TOTAL FEE f � TOTAL FEE f ,� � <br /> FOR OFFICE USE ONIY: <br /> ��TSET011CK AEMSF.TBIICN SIDESETBi1CK f'l�NC11ECMNUApfP fEF REf.E1PTN0 <br /> � J/� I <br /> USE 20ME ioT eae� we�r+t sne FEES VALUATION FEE <br /> ❑YES ❑ NO OUIInIN6 <br /> I <br /> ��aNr uwurwr� .a a owEwNc sze ov e�ocni <br /> UNIfS <br /> riuuqiHc <br /> T <br /> OCCIA�MLY Np(%SI(q(5 OLCU1MNt�p�O B�SEMENi i <br /> 01q1R MECN�NIf.H <br /> ❑YES ❑NO -- — <br /> FINESPRMKLEPHEO'0 RF�SON ��DiIi0N�1 PI�NCNfCK <br /> �—'— <br /> on�en <br /> FIRENMMqEO'0 RE�SON <br /> SIAI[BUIIOMG 511f1C1U0CE i <br /> rrveo�cor�sr r�nNs�oraoveoev qTYOFEVERE7T rumir,wOnKs <br /> LOCAISALES �-- — - __ <br /> o�iE TAX CODE IS 3105 TOTAL <br />