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APPLICATIC.J FOR CONSTRUC7 JN PERMIT <br /> CITY OF EVERETf•6UILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 88201 •259-BB10 <br /> � ��uT�� O COMBINATION � BUILDING ❑ �IECHANICAL ❑ PLUMBING ❑ SNiN <br /> PROJECT ADDRE8S: � � .2o�C�� G(/��� <br /> �� MM110pNE55 C17Y ZiP PIqNE — <br /> 2��Z � n��'4 „b��L��( .2h 2. F(2 <br /> IUM YNL11UpE55 Gtr ilo PHONE <br /> Mp�nIECTOR0E51f1NER /� WI1110qiE55 <br /> OENEI N . �'C 1L�!�UDRE 5 S ��`� '� c���`�V b'l�/�l�I L�Z �V O <br /> �aq � c�Y IR` MqHE SI�TE IICFNSE• <br /> �"' cwm�c*an urxw�ss air xiv PIIpNE ST�TE LICENSE� <br /> � CONTRACTOq Y4l�Op1E55 dTY 11P PIqNE STAIELICFNSE� <br /> COMTRACi PNCE OF N0111t _ <br /> �J'�I� HEATING SYSTEM: T�GAS ❑ ELECTRIC ❑ <br /> ���o SOUME FOOT��Vi� � CONTIICT iER50N AIA PIIOHE Iq <br /> n�l� �l.�N� <br /> X � <br /> �fi� Q/ I HEREBY CEPIIFY THAT I HAVE READ AND E%AMINED THIS <br /> 5[oriar0 vse or euaprq APPLICATION AND KNOW THE SAME TO BE TAUE AND CORRECT ALL <br /> FROVISIONS OF UWS AND ORDINANCES f30VEii�Y1N0 THIS TYPE OF <br /> �y�pE �p��.����op n N���S' � N10RK WILL BE COMPLIED WITH WHETHER SPFCiFIED HEREIN OR <br /> NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> 1O �� a� AUiHORIiY TO VIOLATE OH CANCEL TNE PROVISION OF ANY <br /> r� Z �D� �"✓ � � P RFORMANCE OF CONSTRUCTEON,LTHANT�I AMI AUT11piIZEp gy THE <br /> ,/3,�0 �a� ,O OWNER OF THIS PROPEHTY TO PEqFORM THE WORK FOR WHICH <br /> ti / p00'� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �a T'u o�M�R CONTAACTORS UW 1827 qCW AND 298200 WAC. <br /> ��,�����«.��.,�«�p x 3:rs'-96 <br /> 513N�T E DI1TE <br /> arvAry rEss��usc ra � -- <br /> ��� MECf1AtNCAL ---- <br /> NO. TY►E OF RXi1ME OR REM FEE NO. TYPE Of EOUIrMEIfi FEE -- <br /> WATER CIOSET(TOILET) , �_��� — <br /> ��� ' FORCED AIR SVSTEMS � <br /> IAVATOqY(WASM BASIN) � ' - <br /> . HEAT PUUP , <br /> &bWER ' UNITNEATERS � <br /> KRCHEN SINK 8 DISP i CLOTHES DRYERS <br /> qS11WASNER � RANOE HOOD � <br /> LAUIDHY TRI1Y ; WA1ER HEATER � <br /> CLOTTIES WASHER � WOOp STOVE <br /> �� ' MEfAL FlqEPLACE pN000 BURNING) � <br /> DRINKMIO F011hfrAlN i flREPLACE INSERT(WOOD BURNING) � <br /> ����MN ` GAS flREPLACE � <br /> BACKFLOW PREVENTERS ; CaAS RANGE � <br /> SMIK(SEMICE—BAq,ETC.) � GA$pIpMG � <br /> '^` �:1 ' ' IXHAUST FAN <br /> � � <br /> i � <br /> i � <br /> � � <br /> SUB TOTAI, { � SUB TOTAL S ' <br /> PERMIT 1 � PERMIT f i <br /> TOTALFEE S � TOTALFEE S <br /> FOR OFFlCE USE ONLV: <br /> ��T�T�� � �EM SFTMCK SiOE SETB�CIt PlM1 CIIECI(NUMBER fEF q[f.E1PT NO <br /> �-�J � / ' �//// . /O <br /> ��z� ������ �"�"NT�� FEES VAIUATION FEE <br /> ❑YES ❑r10 euiorc�c <br /> �(D�O � 700 <br /> 11EI6N7 UMT��pr�.,,� r10 a owcuma sizE or eionni • <br /> li UH�fS <br /> F. p �������� <br /> wxvv�Hcr �o a s�rncs occwuir io�o B�SEMEHT � <br /> MECNWIUL � <br /> � ❑YES 0 <br /> FlHESPRINKLERREOD RFASpN �Dd110H11i`I�NCNEGN <br /> ---i-- <br /> FME uMM REO'D OiNER <br /> RE�CpN <br /> ST�tE BUR�INC SIIf1CN�nGE {. :-� <br /> ` y� <br /> TWEOff,ppST PUNS�PMIOVEDBV CITYOFEVERETT �UBIif,WORNS <br /> � �t J� LOCAL SALES � _��_ <br /> w oert '�4 94. TAX COOE IS 3105 TOTAL �� �-�, <br />