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APPLICATIC� FOR CONSTRUCT_ �N PERMI� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COM81NATfON O BUILDINfi ❑ MECHANICAL p PLUMBING ❑ SICiN <br /> PROJECT ADDR SS: �� �� <br /> Vh�n vi �' �,�,� <br /> �f��l / MNL�OORE55 dTY 21P PIqNE <br /> /Y1���urr ���RL�.Pv 1a0 ;�''- ���`�� vr�fJ�(,,[/��'��}o� aoC-as� 3o�Z - <br /> 7E/UNf 4All/�G7RE55 CITY 11V � VHONE <br /> ARGIITECT flESIC�IER IMIlAD/d1E55 CIIY ZIP PH E ' <br /> ���- �.��Y1�2. (NG . I ra ���� u� NE C.�� S�s,ous u ��� <br /> r� ca+tt�cror+ � 'e�5 CI Y Zif` PFONE SI�TEUCEHSE� <br /> 33 �F-�N/l <br /> YECN�NICKCON7BACTOR MMI�DORE55 CI7V 21P P E STATELICENSE/ <br /> PIUIlRlG CONTMCTpi MML�ODSiESS CITY ZIP PYIpNE STATE LICENSE� <br /> Cd1TMCT PRICE OF WOPK <br /> HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br /> Q,{�SG114E WOfYf AND SOU FOOTA6E VOLVED CONTACT PERSON�ND P{qNE Np. <br /> l� GY 0.S � <br /> � � e ,6 0 <br /> ,� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> p�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> . PROVISIONS OF LAWS ANO ORDINANCES GOVEHNING THIS TVPE OF , <br /> � � WORK WILL BE CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �oKoescqpn N ipaop (SIIO�MIBELOWORATT�LNiWOCOPIES� NpT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUME TO 61VE <br /> ipT xoc�c pF AUTHORITY TO VIOUTE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RECiULATtNa CONSTRUCTION OR THE <br /> PERFORMANCE OF CANSTRUCTION.THAT I AM AUTHOHIZED BY TME <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> v��rac i.o.r�w�n CONTRACTORS LAW 18.27 RC/W�AND 2982 D WAC. <br /> CONSiHIICTpN IOAN LENDER.ADMESS.h_cP1qHE NUMBER Y //�.�� ((/ vY � l�7LJ <br /> ATUNE OATE <br /> ' CIiY BUSINESS LICENSE N0. <br /> PLUMBMW MECHANICAL <br /> N0. TVPE OF FlXTURE OR ITEM FEE NO. TVPE OF EpU1pMENT FEE <br /> WATER CLOSET(TOILEn � NC—NHNDLO UNfTS ' <br /> BATHTUB ; FORCED AIR SVSTEMS ; - <br /> LAVATORV(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNITHEATERS ' <br /> KRCHEN SINK 8 DISP - ; CLOTHES DRYERS � <br /> DISHWASHER � RANGEHOOD � � <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � <br /> �pprp� � MEfAL FIREPUICE(WOOD BURNING) ' <br /> DRINKIN6 FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPUICE ' <br /> BACKFLOWPREVENTERS ; GASRANGE NG S Gd �00 <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING 6 ' <br /> � IXHAUST FAN ' <br /> � <br /> i � <br /> i � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S � O ; <br /> PERMIT S � PERMIT S �S � <br /> TOTAL FEE S ' TOTAL FEE S S' ' <br /> FOR OFFICE USE ONLY: <br /> FNOMf SE7BALK PEM SETB/�LN SIOE SET&1LK VtM!CHECN NUMBER FEE RECEIPT NO <br /> '�/(���;� <br /> � <br /> usemne IOTARE� VAC�NTSITE FEES VALUATION FEE <br /> ❑YES ❑ � BUILDIN6 � <br /> i <br /> IIEIGNTL1GpT�T10N NO.OFDWELl1NG SREpFBIpG/fl � <br /> UNITS P�UMBINC 4 <br /> Q�U�Y Iq Oi SIptlES OCCUPANT LOAD B�SEMENT MECH�NIC�L � <br /> � <br /> ❑YES ❑NO — ; <br /> iIflESPRINKLERflEO'0 REASON �DDITION�LPLANCHF.CK <br /> OTNER � <br /> i <br /> i <br /> FIPEMMMflEO'D RE�SON i <br /> ST�TE BUIIpMfi SURLNAqGE i <br /> troEOFr,oNsr PLANSMPROVEDBV CITYOFEVERE7T �'1iB11CWOPKS <br /> LOCAL SALES --� <br /> DATE TAX CODE IS 3105 TOTAI � <br />