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APPLICATI6�J FOR CONSTRUCT�N PERMIT/ <br /> CITY OF EVERETT•BUILDING DIVISION L�C� <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-Bd10 � <br /> ❑ DEMOUTION ❑ COMBMATWN ❑ BUILDINfi �MECHANICAL p PLUMBING ❑ SNiN <br /> PROJECT ADDRESS: ���J���n1 ) l t , C 4C'?/ <br /> �1P�4'ciA ���E c� � ��„4,��i.5:�- z�P--���,' � -��7" 3� � <br /> ����A ' i���c=��55 Lev�. ��,�,c�F.�/ S� ��/ yA�a� �� �7 � <br /> terwrt uui ss un z�v rna+c <br /> C d10E5�N/EH MNL�pORE55 � Cltt `1/ <br /> �_ �,///�`/,' /J ��C ���J f�.--�lChHf—t-7� ^�i/ � PHONE� � � <br /> ' �� //!/// / f /� //��� �J J (7/ <br /> NE�uICOMIR�GTO{i MIJ��(;111E55 � CIfY III+ PII�! SI�N • <br /> �����.� 4u�,�5s ��1� � ��i.rf��3�'..2 <br /> �n' ZIP P110NE ST11TE tICE SE� <br /> PLUI�R1GCp1TR4CTOR 4141�Od1ES5 �� �� SIP P110NE SUTELIGENSE• <br /> � ��2 l_ <br /> COM7R�Gi PRCE OF WOlit y� <br /> • ' ff� (J �` HEATING SYSTEM: GAS �ELECTRIC ❑ <br /> ces�c�ee waac�rq sou�rooT�wvavEo ca�r•cr vEasori ua vr1onE ra <br /> �2 n _ - - � / <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ' <br /> p��o���� APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lEMl0E5CNPf10NOFPIqPERTY(SIqWHlELOWp1ATLICIITNOCORES) NpT. THE �RANTIN(i OF A PERMIT DOES NOT PRESUME TO 61VE <br /> im s�oac ot AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHEF STAtE OR LOCAL LAW RE6ULATINO IX1NS7AUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TNAT I AM AUTHORIZED BV THr <br /> OWNER OF THIS PROPERTY TO PERFOqM THE WORK FUR WHIGH <br /> APPIICATION IS M D �OMPLY WITH THE STATE <br /> rwwear��.o.rAe,aen� CONTRACTORS C D 96200WHC. <br /> ' � � x ./� �Co <br /> CONSTRIILiqNLOM/IENDER.I100i1ES5.TElEP M141lEP <br /> � SNiI1�T1111E D�TE <br /> . pTY BVSINESS LiCENSE NO <br /> � K�d MECHIINICAL <br /> ND. TYPE OF RXiU11E OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNOLA UNfTS � <br /> �THT� ' FORCED AIR SVSTEMS ' <br /> UVATORY(1NASH BASIN� � HEAT PUMP , <br /> �p�R ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES DRYERS ' <br /> OISHWASHER � RANGE HOOD � <br /> IAUNDRV TRAY ; WATER HEATER � <br /> � CIOTNES WASHER � YJOOD STOVE � <br /> URINAL � MEfAL FIREPUCE(WOOD BURNING) ' <br /> ORIPMMKi FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FIOOR DRMN � G/tiS FIREPLACE � <br /> BACKROW PREVENTERS ; 3AS RANGE � <br /> SMM(SERVICE—BAR,E7C.) GAS PIPING <br /> IXHAUST FAN <br /> i � <br /> i � <br /> SUB TOTAL f ' SUB TOTAL f � <br /> PERMIT S PERMIT S i <br /> TOTAL FEE f � TOTAL FEE S <br /> FOR OFFIC�USE ONLY: <br /> FIkINT SFis/�p( REAR$ETlIICN SIOE SETO�CIt PL�N C11ECR NUNBFR FEF RECEIPI NO <br /> use zor� ior auE� v�cu�i sirc FEES VAlUAT10N FEE <br /> ��5 � � BUIIDINC. <br /> i <br /> IIEIOHTLMMi�(ION NOOiDWELLIMb 512EOFBlDOR1 i <br /> UNIfS p�pldglNG <br /> I <br /> OCQRANLY MObfSI(MY[5 OLCUPANTlO�� BASEMEN7 NECNWIC�I I <br /> GNdF <br /> ❑YES ❑NO � <br /> i <br /> FMESPNINKIERREOD RF�SON �ODIIION�LMANCNf.CK <br /> OLHER <br /> FlREMMMRE-0'0 REAcpN <br /> St�IE BWIDINC•SIIRCN�R6E <br /> i <br /> TYPEOif,ONST PL�NS�P1'ROVEDBY CITYOFEVERETT �UBIIf.WORNS <br /> LOCAL SALES —�— <br /> osrE TAX CODE IS 3105 TorAL <br />