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APPLICATIL.� FOR CONSTRUCI .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT, WA 98201 •259-8819 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING C] MECHANICAL ❑ PLUMBING ❑ SIGN <br /> ci�T ADDRESS: �� vv�Ti��IOP� ��' �f/.E�'T Yvi�. ��-W/L1/�I� j�f Q_/L. <br /> Cli4'-� �/ YL�'7�i�OF��`I!�'6' G�2cieET! 802Q � <br /> ON'11ER M4l 5 CIIY I�P F�WNE <br /> c��f�S /g�t71�' �� n <br /> G�'+.�Q7` f�7f'Z� cwi�p—;sq,� �y � urv zio r��or�E <br /> Rm7F s1�iRA ,�-� �r,�-r c2C' TnE' y4. 9B/o9 'Il�(o- '28S- 77c10 <br /> MGM*[CiORDESiGr+En cun�nonEss dtr Iin PNOHE <br /> �o �t/czr�,tror �r �,�,;u�o. <br /> OENEMLCONTMCTq1 Mn��pp{I[55 CILY IIP PIIONE $I�fEUCENSE� <br /> MECNNlIGIGWttUCTOR MML1100RE55 f.ITY IIP P11p.E CT�iELII'ENSE� <br /> RVAlMCCONTRFCfOR M4LAOORE55 Gtt IIP PHONE SUIELILENSE� <br /> CANfR�T PRICE pF W(M1R <br /> E�C/Sr T �/P/dI(y <br /> .3� �� HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OE9p11SE Wqll(MA SG1ME f00T1GE MVOlVEO CO4T�CT PERSON�NO PMONE NO <br /> F/GriR.47icw 4� �'6' s/�- .4�V - 'ZPX�-28S-770D <br /> AV 2N,� �l.o�/l A'c �Y.1'dtf'�iS f�1iP/.L — <br /> 3SDO �/ • 1 HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> yiqpp�p����p�p APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT ALL <br /> �'� � � ��'X•.✓�dtvr PROVIS�GNS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> '�����W' WORK WILL BE COMPLIED WITH WHETHE9 SPECIfIED HENEIN OR <br /> `En�o�scn^T�a+ar'ar¢aTMtsxowwee�owon�n�cHtwocooiesl NOT. THE GRANTIN(i OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �aT �ocK a_ AUTHORITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY <br /> OTHER STATE OR LOCAL LAW qEGUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.iHAT I AM AUTHORIIED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TME WORK FOR WMICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> �L i�x i.o.M�q CON TORS LFW .27 RCW AND 296200 WAC. <br /> � fAMSi�NILiION lON7 LE/AEq.Md1E55.iElEP11d1E M/1A9ER X , ��,'�� <br /> , SM,N NRE D�TE <br /> lIISINESS LICFNSE NO. <br /> xu�rro .cH�rnc�� <br /> NO. TYPE OF FlKTLRE OR ITEM FEE ND. TYPE OF EOUIPMFNT FEE <br /> / WATER CLOSET(TOILEn � NC—I�MNp�a UNfTS � <br /> BATHTUB ; FORCED P;A SYSTEMS � <br /> LAVATORY ' ' <br /> (Wh3H BASIN) i HEAT PU'dP , <br /> �WER ' UNITHEATERS i <br /> KITCHEN SIiiK 8 DISP � CLOTHES DRVERS ; <br /> DISHWASHER � RANGE HOOD �, '— <br /> UUNDRY TiIAY ; WATER HEATER � <br /> ' ClOT!iE��YABHER � WOODSTOVE , <br /> URINAL � MEfAL FIREPLACE(WOOD F3URNING) � <br /> DRIMKIt�(3 FOUNTAfN ; FIREPUCE INSERT pNOOD BURNING) <br /> FlOOA URAIN � OA9 FIREPLACE � <br /> BACKFLOW PREVENTERS ; GAS RqNGE � <br /> SINK(SERVICE—BAR,ETC.) � (3A3 PIPING , <br /> IXHAUST FAN <br /> � , <br /> � � 7 � <br /> � EX/ST' CiV U G9� � <br /> _ , <br /> SUB TOTAL S ; SUO TOTAL E ' <br /> PERMIT f i PERMIT S , <br /> TOTAL FEE S � TOTAL FEE f <br /> FOR OFFlCE USE ONLY: <br /> �AOMt SETPIIG( REAq$Ei&�CK S�DE SETB�CM 1'�AH CIIECM NU1.�ER,� FEf �� 'REf.EIPi NO <br /> � �// <br /> USE2d/E ioT�aen V�L�NISITE FEES VALU�TION FEE <br /> ❑YES ❑� OUILOINC <br /> � •� <br /> IIEIOHT tIMIT�TION NO Ot OWELLIHG SIZE OF BIOGRI <br /> UNIiS � <br /> 2T./N C / �11/M01NG ' <br /> J:4(/ <br /> KK F�NCY MO C{5104F5 OCCUPANT LO�[) B�SEMENi MECN�NICAL � <br /> Z ��� DYES �Hp - <br /> FlRESPFIINKIERqEO'0 RE�SON AppIIIONALPUNC��F.GN <br /> Ala --�-- <br /> OTPER i <br /> FIRE�URMREO'D RE�Sp1 �� <br /> N� sTeiEnunowc5unc�unGE — -- i/ ;t!/� <br /> �.�_�1./S� <br /> TYPEOPf,pNST CI�NSAPPpOVEOBY CITYOFEVERETT �IIflIIf,WpRKS � <br /> �f � IOCAL SALES — ' <br /> oaE TA1(CODE IS 31Q5 TOiAL �!�/� �(� <br />