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APPLICATIC'1 FOR CONSTRUC7_JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COM8INATION p BUILDING � MECHANICAL ❑ PLUTABING O SIGN <br /> P OJECT ADDRESS: 1. <br /> �gERT I�E��"�►.1 1`11� W �MORE AdE �fFo�T WA�tb�Dl �5���_ <br /> OYN/ER MUL�ODf1E55 pTV ZIP P110NE <br /> SAME _ <br /> IEIUNT MWL�DO{1E55 GTV Z�V PNpNE <br /> MCMTEGTOROESIG/IER /MIIMpRE55 G�fV IIP PMpNE <br /> GENEMLCp1TW�CTdi N1Ul Wq1E55 CITY Ii� PiIONE Sf�TE IICENSF• <br /> �U�`�iL E1J6RhY �4�T�MS� T•�r 1�1a� b4+� „F . �yU1� wA 5�Q3(D 3er•,L�SQLb.3.3�. <br /> MECM�MCQ CON7/UCTOi1 MIUI 55 Cltt ZIF P110NE STRE UCENSE� <br /> RU6lMC CONTNAGTOR MNL AppqE55 CIfY 21P PHONE ST�TE IICENSE• <br /> GONIMCT VIiCE OF MIORII� <br /> � HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> OE9L711�lE Wp1K AND SOU�RE i00G0E NVOlVEO CONIACT PERSON�!q PMONE NO <br /> ' eN M <br /> � ��4-B3 t5 <br /> I HEREBY CERTIFV 'HAT 1 NAVE READ AND EXAMINED TNIS <br /> �p���� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF . <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �o�uoescwarawovrnoreants��owne¢�owon�rt�cNtwocaaesl NOT. THE OHANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�odc pr AUTHORITV TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGUTATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> ONMER OF THIS PROPEHTV TO PERFORM THE WORK fOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> veqcE�nuci.o i �n _ 1 CONTR�S L W B27 RCW AND 298.200 WAC. <br /> CONSiR11CT10N lON1lEN0ER.Md1E53.TELERIOqE MJMlEP �^�O � �fj <br /> SNiNITURE O�TE <br /> CITY&1$IHE$$U�EHSE NO <br /> K�� MECHANICAL <br /> NO. TVPE OF FlXTIMIE OR REM FEE NO. TYPE OF EOIJIPMEM FEE <br /> WATERCIOSET(TOILET) � A/C—AMNDLOUNfTS � <br /> �THT� ; FORCEDAIRSVSTEMS � <br /> � <br /> � <br /> UVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER ' UNIT HEATERS � <br /> KRCHEN SINK 6 DISP i CLOTHES DRVERS ; <br /> OISHWASMER � RANGE HOOD � <br /> UUNDRY?AAV ' WATERHEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL � MEfAL FIHEPLACE(WOOD BURNING) � <br /> ORINKINO FOUNTAIN i flREPLACE INSEHT(WOOD BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ; <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING <br /> ' IXHAUSTFAN � <br /> � ; <br /> � , <br /> � <br /> SUB TOTAL S ; SUB TOTAL S � ; <br /> PERMIT S i PERMIT S .j i <br /> TOTAIFEE f � TOTALFEE S � � <br /> FOR OFFICE USE ONLY: <br /> �NOMTSFTB11L1( PEMSETB�CN SIpESETBACk P��NCIIEC1fNUMHfP fF.= RFf.FIPiNO <br /> uSE 2oeE ior��� vr�cua s�tE FEES VALUATION FEE <br /> ❑ves ❑no euinwc ' <br /> I <br /> HEIGHT UMT�TION NO OF OVIEIUNG SIZE OF BLIXi/f.l ; <br /> UN115 PLIIMBMO <br /> ��NCY NO Of 51(MbFS OLCUP�NT LO�D B�SEMENT � <br /> MECN�NiCM i <br /> ❑YES ❑NO -- <br /> FIHESPRINKIERREO'D RF�SON �DDIIION�lP1�NCHfCM <br /> --�-- <br /> Ol11EP <br /> fIREMMMREO'D REA5011 <br /> ST�IE BW101N0 SIIRCH�A6E <br /> TYPEOFf,pNST Pl�NSAPPpOVEOBY CITYOFEVEREIT ���BIif,WORKS <br /> LOCALSALES --- <br /> o•re TAX CODE IS 3105 TOTAL <br />