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APPLICATIO. _ FOR COI�fSTRUCTL �N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> ❑ DEMOLITION C; COMBINATION ❑ BUILDIN �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: ��y Z 3 � F�1I� (�.� <br /> OMMER M�IL�DORE55 CITY IIP pHpNE <br /> Spc.k B�-ss so�y 23 cJ E�r y�zo3 - <br /> 7ENANT MNLADORE55 I;ITY 71P PIIONE <br /> ARLPoI[CTpiDESIGNER M�IIAOORE55 GTY )IP PHONE <br /> GENEIUICONTRI1CTOq MALAWR[55 CIfY 7if PIIONE $GTELICENSE• <br /> MECNANICK CONTPA�TOR M�II�DORE55 CITY 71P PNONE STATE IICENSE I <br /> �JO�hC�•1 �U.�/�G �20Z CIf6TNv7' "� Ev i I`�LU� 3S3`�35��/ .�,�41/f�.(OSLD3 <br /> PLUMB►IGCONTR�CTOII M�ILAWRE55 GITY Im PNONE STATELICENSE� <br /> CONifUCT PipCE OF YYORIc <br /> ZOOp oa HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ <br /> OESCRlE MqRK AND Sd1AHE F00TI1GE MIVOLVED f.ONT�CT f'C11SON I1ND PNONE Np <br /> N�-n,e►� co,vvErLs�o•J <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> p�pp��p����q� ��� APPLICATION AND KNOW THE SAME TC BE TRUE AND CORRECT ALL , <br /> PHOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HfREIN OR <br /> �c�oEscrovtar+avaorenn'Is��ownaeiow�on�n�cHTwocovie5l NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br /> ioT e�ocK oF_ AUTHORITY TO VIOL0.7E OR CANCEL THE PROVISION OF ANY <br /> O7HER STATE OR LC�AL LAW qE6ULATIN6 CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8V THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> v�ncE�iNc i.o.Mwre�p CONTRACTORS LAW 1827 RCW D 296200 WqC. <br /> G// Q <br /> COMSTRUCTIONIOANLENDER.hWPE55.TELEP110NEM1GBER ��5-/ {p <br /> SIGNATUfI UQE <br /> CIlYBU51NE55lN;ENSf NO <br /> �V�� MECHANICAL <br /> NO. TYPE OF flXTUpB Op ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> ' WATER CLOSET(TOILE� � NC—i1/FINDL6 UNf i8 �— . <br /> BATriTUB ; FORCEDAIRSYSTEMS � <br /> UVATORV(WASH BASIN) � HEAT PUMP , <br /> S��R � ' UNIT HEATERS � <br /> KITCHEN SINK 8 DISP ; CLOTHES ORVERS ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY THAY ; WATER HEATER � <br /> CLOTHES WASHEH � WOODSTOVE , <br /> URINAL � MEfAL FIREPIACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT(WOOD BURNING) � � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE ' <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> EXHAUSTFAN � <br /> i <br /> ' S 6 � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL t �— <br /> PERMIT S i PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSEtR�CK pEMSETB�CK SIDESETBACK PUNCIIEGNNUMCff1 fEF RECEIPTNO <br /> USEIONE IOTAPEA V�C�NTSItE FEES VALUATION FEE <br /> _ ❑YES ❑ NO O1111�ING i <br /> i <br /> NEI6HT LIMIT�TION NO OF DWELLING SqE OF BLOGRI — <br /> UNIf$ Pl II�OING � <br /> OLCUPANCY tq OfSf(NaFS OCCUPANTLOAD B�SEMENT —F <br /> 61qUP MFC��ANIf.M i <br /> ❑YES ❑NO � - <br /> •UDIIIONN.PL�N G11f Gk <br /> flRESMUNKLEqpEO'0 RFASON � <br /> � _ <br /> ouien I <br /> FIREAIARMREO'D RF�S(Xu � <br /> 51NE 911111)W6 SIII1CIUqGE <br /> i <br /> rvvE a r,orisT VLANS�PPPOVED BY CITY OF EVERE7T ruei ir.wnnKs <br /> LOCAL SALES -- --�— <br /> oere TAx COD6 IS 3105 TOTAL ; <br />