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APPLICATIOtr FOR CONSTRUCTIt�N PERMIT <br /> CIN OF EVERETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVEREIT,WA 98201 •(425)257-8810 <br /> ❑ OEMOLITION ❑ COMBINAT�ON ❑ BUILDING ❑ MECHANICAL O PIUMBING O SION <br /> PR/OJECT AD�D+RESS: /�� %� `t/��j»Ur�/JiF <br /> �C L`-c>�/,/nc.�.✓ �.y � �j C�/ / E✓E/1 92'�/ �/ <br /> OWNER MMl�00RE55 � C F/�)Git nG�E �i. �S.z ' �O / <br /> CI ZIP PHONC <br /> TEN�NT uMlAppqE55 <br /> CITY llP G��ONE <br /> •FCM�TF.GTOPDESIGNEn Mu�ADDRE55 � ' <br /> PTY )iP PHONF <br /> GF.NEfUL CONTp�CTpq M�II�O�RE55 --- <br /> /�C17Y i�P PI1fJ4E $IAIE IICFNSE 1 <br /> AUc` �S ..�.✓5�o/%^7�-'0�✓ i ''70/ />i%A �a/Av i� 1!' �/6�/ <br /> � MECHINIL�I CDNTR�CiUR M�II�DDRE55 �E E- �"�O/ -7� ' /�i�UES iiD tnn/S <br /> ��TM r�� Pf OM1f SGfF 11�EN5E/ <br /> iIUMIBMGCONiR1f;TpR MUL�DOqE55 <br /> ��TM z�P PNONE <br /> STRE UCENSE• <br /> CONiR�Li PqI�E OF WpqK <br /> -- �OOCo HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> DESCRIBEWOqK�NDSW�REFOpUGEp/VOlyEO <br /> ,L� /'i� / ��NI�CT PCRSONNID PMpNF.NO <br /> �i.✓ " A� r i✓D� l✓ <br /> f7E c7- <br /> I HEREBY CERTIFY THqT I HAVE READ AND E%AMINED TNIS <br /> P�'OSED VSE OF BUILDIN6 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGQDESGRIPTIpNpFp{pp[pry�5�pyy�,�BEIOWOR�TiACHTWp�OPIE51 WORK W�LL BE COMPUED WITH WHEI'HER SPECIFIEO HEREIN OR <br /> ioT NOT. THE GRANTING OF q PERMIT DOES NOT PqESUME TQ �31VE <br /> B��K °f AUTHORITY TO VIOLATE OR GANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> _ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE qND I COMPLV WITH TME STATE <br /> wr+cEi ux i.o.r/uMeEa CONTRACTpRS LAW t827 qCW AND 2g6.200 WAC. <br /> CONSTqUCTIfXI LO�N IENpEP.11ppqE55.TEtEPHONE NIMBER � �i f���H/ <br /> x_ ��. �0-�3- 97 <br /> SIGN�TURE p�r� <br /> � CITY OUSINESS 110EN5E NO <br /> � . PLUMBIN6 MECNANICAL <br /> r �• TYPE OF fl)lTUHE GR ITEIN FEE NO. TVPE OF EOUIPMENT <br /> � WATER CLOSET(701LET) FEE <br /> ' A/C—M�INDLGUNITS � ` -'�—�- <br /> BATH7UB � FORCEDAIRSYSTER!S <br /> LAVATORY(WqSH BASIN) � HEAT PUMP —�— <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINK 3 DISP � ; CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAV ' � WATER HEATEF � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) �-- <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE � <br /> BACKFIOW PREVENTERS ' GASRANGE , <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING <br /> ' E%HAUSTFAN <br /> � <br /> � <br /> � ' <br /> � <br /> SUB TOTAL E � SUB TOTA� E <br /> PERMIT E � PERMIT E /S� <br /> TOTAL FEE S TOTq�FEE f ,��— <br /> FOq OFFICE USE ONLY: <br /> fppNTSFTp�Lk RF�RSFiB�CK SIDESEIB�CN PUHCn[CNNUM R (EF RFCFIPfVO <br /> IISE IONF ����� <br /> io�""E" v�c�Ni srte FEES VALUATION FEE <br /> ❑rE5 ❑ No --�-T-- <br /> 11[IGIII I IMII�1104 9U11 DIN. <br /> HO Of DWEIIIHG SIIE OF gLDG41 <br /> IINIIS '- <br /> PI UA�P W C <br /> OCCIIP�Nf,Y HO 04 5lpqif5 p[:LUP1N1 LD:U -- —t__._ <br /> GIiOUa B�Sf1AEN1 —' - ----"- <br /> MFf,11�N�f.AI <br /> OYES ❑NO � _____ <br /> i'IRESPRINNLERREO'0 fif�50N nODiItpN41.PIANG��f.f.K <br /> �.�_��_7_- _ <br /> FIRERIAFMqEO'0 RFA$pV OIHER <br /> SIN('Bllllf)ING SU�CN�R(iC <br /> 1YCEO�f.py51 PI�NS�PPPOVFDBY "---- -_ <br /> CITY OF EVERETT runi ir,wo�as <br /> LOCAL SALES -- _ _ ' <br /> naie TAX CODE IS 3105 TOTAI <br />