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APPLICATIL� FOR CONSTRUC7 _JN PERMIT <br /> CITY OF EVERETT•BUILDING OIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION p COMBINATION ❑ BUILDING I�MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: "Z � � � 5�,.� �� �F �,�.�--I �fy} �e�p/ <br /> �-}t_ RC'S�on,n-r.i'on.) j7_//z� VFG/�.s�S <br /> OYIHER MMLAOORE55 GITY ZiP PNpNE <br /> J7 � C, 2[-s?Uti�oi� l�u//•n�,� %���� �. 1���I�� �'3��� i�la��...� i� ,�✓�d�.� <br /> TEN/J/T MNl 5 GIIY IIP Po�OHE <br /> •RCMTEGTp1DE51GNER M�It�DDRE55 p1V )m ��IONF <br /> GENEMLCONTR�CTOR M1Ul�ODt1E55 CiiY )IP PIIOHE SGIEIIG[NSE� <br /> MECMMACQCLWTR�CTOR MIJlA00RE55 f.ITV ZIP PIIONE Si�TELICENSE� <br /> �EM�73?� r�S �uv�9tc..J� A✓c �o.�a �,. 9�1 /tvo 2�,2 '7A�� Fl![E.n�E���4 <br /> PLU4lkIGCONTRIWTOR MMLADDRESS �� CI1Y Tlv P11pNE STAIEIICENSE� <br /> C011i1NG1 PIiCE OF Nq11N <br /> Q„ Q HEATING SYSTEM: ❑GAS ❑ EIECTRIC ❑ <br /> OE5f�1ME WdiK�N�Sd1�RE FOOT/�GE MVOIVEg-. CONT�Cf PERSONAMO P11OHE NO <br /> �Z'-2F J tI�/LC'�Sl�,l ELt�a,J E. -c - <br /> /9✓ �a .Oo /-B6U - 3�� _ U <br /> r�-- •� I HEREBY CERTII'Y THAT 1 HAVE READ AND E%AMINED THIS <br /> r'arosEo usE oF ainidric APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> U �� PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORN WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> lEMLOE$CPoPTIONOFPRpPERTY�$IqNV9ElOW011A /iCN7wOCONES) NOT. THE ORANTINCi OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK or AUTHORITY TO VICLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAN REGUUTINO CONSTRUCTION OR TFiE <br /> PERFORMANCE OF CONSTRUCTION.THAT I M AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERF TME WORK FOR WHICH <br /> APPLICATION IS MADE AND I PLY WITH TME STATE <br /> p�+cE�T�x�p r�ui R CONTRACTORS UW 18.27 RCW A � 96.200 WAC. <br /> CONSiRUCTIONIOIJIL DER.�ODPESS.IElEP110MENUMEFR x / <br /> SIGNATURE O�TE <br /> CIIY BUSINE55 LICENSE NO <br /> � � PLUMBIN6 MECHANIGL <br /> � NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � NC—ARiNDLO UNfTS � <br /> BATHTUB ; FORI:ED AIR SYSTEMS ; <br /> UVATORY(WASH BASIN) � HEAT PUMP � <br /> SMOWER � UNIT IIEATERS <br /> KITCHEN SINK 6 DISP � CLOTHES DRVERS � <br /> DISHWASHER � HANGE HOOD � <br /> LAVNDRY TRAV � WATER HEAT[R ; <br /> CIOTHES WASHER i WOOD STOVE <br /> URINAL � � METAL F;REPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT pN00D BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKROW PREVENTERS ; GAS RANGE ; � <br /> SINK(SERVICE—BAR.ETC.) � GAS PIPINii <br /> � IXHAUST FAN ' <br /> � <br /> � <br /> i � <br /> � � <br /> � 1 <br /> SUB TOTAL S � SUB TOTAL f ; . <br /> PERMIT S � PERMIT f � <br /> TOTALFEE f ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> IRONTSETPACM FEARSETBACN $IpESETB�CN Pt�NC11ECl(NUMBER fEF RfCFIPINO <br /> ,��'�/ja o a0 <br /> usE ia+e lOT�PE� v�c�r+r s�rE FEES VALUATION FEE <br /> _ ---r— <br /> ❑YES ❑ NO ppIl01N6 <br /> NEI6NT�IMIT�TION NO Ot DwELLIN6 512E Oi BLOGrtI � <br /> UNiiS PIUMBINO � <br /> _____�{— <br /> OCCUPANCY Iq(M SI(NnES OLWPANf LO�D BASEMENT MECN�NIG�t � <br /> OROUP � _ <br /> ❑YES O NO ��- <br /> FIPE SPRINKLER REO'D �F�SON �DDIIIONAL PUN C�ILGN i <br /> ���__ <br /> 011lE� � � � � ��� <br /> FIRENARMREO'D FE��[k� <br /> $GI[qUItO�N.SpnC11�Rf.E <br /> TYPEOFf,ONSi PLnNS�J�ovenev CITYOFEVERE7T runnr.wonKs ____ _____ <br /> �YI • LOCAL SALES <br /> o�iE /� C'� TAX CODE IS 3105 TOTAL <br />