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APPLICATI��:J FOR CONSTRUC7 .�N PERMIT <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOUTION ❑ COM6INATION ❑ BUILDING �MECHANICAL ❑ PLU6IBIN(i ❑ SIGN <br /> PROJECT ADDRESS: <br /> u,Aoe Y,�+� titi�,a WEST �R Ev� ►—, 44aQ.3 �5�9�o.a <br /> OMRIER� 55 pTY 1iP 1 NE <br /> �1�'�` <br /> iE1MNT AWLhOp1E55 CITY IIV f'MONE <br /> �W'MTECip1OE51GNEA MNlM0f1E55 GITT 1�1' VMONE <br /> 6ENFMlCONTRAGTOR MIUL�DORF55 CITY SiP PnONE �f�TEIICENSE• <br /> �oEAL Ef�itGu S�tEMS S�x. 151a► 1.4�+ Au� W L4Nuwoc(M��W--/►.�—J�BIESOb6SN <br /> MEpUMCALCONTRACTOR MMLAOd1E55 � Cltt IIP PNONE ST�TELILENSE� <br /> PLVMeNGCONTP�CTOR MNL�WNESS GIIY Z�P ��qNE Si�TELICENSE� <br /> CONTMCT PIVCE OF WOaK <br /> �3`L�S .�(C _ HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> pE9C111lE WOIN(�Np$q1M1E FODT110E k1VOlVED CONT�CT VERSON/JA VHONE ND <br /> � � <br /> � 1 <br /> I HEREBY GERTIFY THAT I NAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ���°F°�L0�0 PROVISIONS OF UWS AND ORDINIINCES GOVERNING TNIS TVPE OF ' <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lF6KpE5CqPTqNpFPIqPENTY�SIqWHlELOWORATT/iCNTWOCOPIES) NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi eiaa a AUTHORITV TO VIOLATE OR CANCEL TME PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW RE6ULATII�Ki CONSTRUCTION OR THE <br /> PERFOPMANCE OF CONSTRUCTION.THl1T I AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPERTY 70 PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STMTE <br /> IWICEiTiut i.D.Ma.MEa CANTRAC ORS LAW 18.Z7 RCW AND 298.200 WAC. <br /> (1 <br /> Cd157RULT10NlWNLEWER.l100RE55.TELERq11EM111lER x �i4�r � � a3—p` <br /> $1AN�TURE Ol1TE <br /> CITY BUSINESS I�LFNSE NO <br /> p��� MECHANICAL <br /> NO. TYPE OF FlI(71ME OR ITEM FEE NO. 7YPE OF EOUIPMFM FEE <br /> ' WATER CLOSET(TOILEn � NC—AMNDLO UNfTS ' . <br /> g�7F{TUg � FORCEDAIRSYSTEMS � <br /> LAV�' ORY(WASH BASIN) i HEAT PUMP � <br /> �{pyyEq � UNIT HEATERS ' <br /> KITChIEN SINK 8 DISP ; CLOTHES DRVERS � <br /> p�gHyyASHEq � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CIOTHES WASHER � WOOD STOVE <br /> URINAL � MEfAL FIREPLACE(VJOOD BURNING) ' <br /> DRINKINO FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) i <br /> FLOOR DRMN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GASHANGE � <br /> SINK(SERVICE—BAR.ETC.) � uAS PIPING <br /> � IXHAUST FAN <br /> � ' <br /> � ' <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT f � PERMIT S <br /> TOTAL FEE S ' TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> f11pN75ETgKA( PEMSETMCN GIDESETBACK M�NCIIECKNUMBER fEF RECFIPfNO <br /> usezoqe tor�n¢n V�C�NTSITE FEES VALUATION FEE <br /> ❑YES ❑NO � <br /> AWIDINC j <br /> NEM.HTLIMITATION NOOFOY/ELLING $IIEOFBIOGRI � <br /> UNIIS PLIIMBING <br /> � <br /> OCCUPoINCY Iq Of SIMFS DLLUPAN1lO�D B�SEMENT MECH�NiLM <br /> GIqIN <br /> ❑YES ❑NO <br /> FlRESPRINKIFRREO'D pFA50N �DDIf10NeLPLANC��fCN � <br /> �—�— <br /> O1NEli <br /> FlREAURMREO'D AE�SON <br /> ST�IE BUIl01NG SIInCN�nGE <br /> trveo�r,orvsr Pl�NS�PPROVE�fiY CITYOFEVERETT ruenr,wonKs <br /> LOCAL SALES — ------ <br /> o�iE TAX CODE IS 3105 TOTAL _ <br />