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APPLiCATI� FOR CONSTRUC7�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •257-8810 <br /> ❑ DEMOLRION 6t COMBINATION ❑ BUILD�NO O MECHANICAL ❑ PLUMBINO ❑ SION <br /> PROJECT ADDRESS � ,� � <br /> OWNEfl MAltA0DRC55 pIY I�V P�qNE <br /> �J�.ae�e.,r p.o. 8ox i3o 9Nfe�4�,wa °�eoo9 C425) b4L•63"I.� <br /> t[Hurt M+i��oon[ss cin ziv v�rorc - <br /> NiLNR[CiOflO[SGNEP MNL�D�PE55 LILY bP pHLHE <br /> OENERALLONIRACLOP Y�II��DI1E55 CIiY IW MXONE UiELIGENSE• <br /> ��eaame as Ownu " QuApi¢c� 22/OF <br /> MECNANILALCONiRACi0f1 M�ILPpDiiES$ CItY ZIV pN01:� $lA1ELIG[NSC• <br /> PWMBi11GGON1FALiOP MRIL�OOPESi CItY Z�P PNGN[ Si�iELIGfNSE• <br /> CONIR�Ci PRCE OF WORK <br /> p/s,00d HEATING SYSTEM: ❑GAS !si ELECTRIC 17 <br /> �ESCPIBE NOBN RID SOIIN(f W GG[IINCLV[0 GONi�CI�FRSpNµp pNONL NO <br /> �� �yb_< Tn9flru� /O .I�A.Yodt C42B)a9N-B373 <br /> }I � �L <br /> I HEREBY CERTIFY THAT I MAVE flEAO AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT.ALL <br /> vaoPoseo uss oF owm�rm PROVISIONS OF LAWS AND ORDINANCES GOVERNING 7MIS tYPE OF <br /> WORK WILL BE COMPLIED WITM WMETHER SPE::IFIED HEREIN OR <br /> t[cnioescn�nrior+avnoneerv�s�oneoaowonniucHrxocowcsi NOL TME GRANTING OF A PEqMIT DOES NOT PRESUME TO GIVE <br /> ior'7��_eiocrc or CI AUTHOFITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> �/y�„�,.,_�� ���� OTHER STATE OP LOCAL LAY!REGULATIN�CONSTRUCTION�R THE <br /> --��"T PERFORMANCE OF CONSTRUCTION.TMAT I AM AUTHORREL BV THE <br /> OWNER OF THIS PROPERN TO PERFORM TME WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITM THE STATE <br /> aeacn rex io use.Y� f^ CONTRACTORS LAW te 27 RCW AND 296200 WaC. <br /> l��.v ��CJ <br /> eorvsrauctrorvio�Ni[rrocn..00ness.*[�crHoxcr�uueca X �yY�� 7///�D/ <br /> scH� ne on bChY QalAO/��t ou[ <br /> CRY BOSMESS IiLENSE NO <br /> PLUMBING MECNRNICAL <br /> NO. TYPE OF FI%TUflE Ofl ITEM FEE NO. TYPE OF EOUIPMEN'i FEE <br /> � WATERCLOSET(TOILET) NC—AMNDLGUNITS <br /> BATNTUB FORCED AIR SYSTEMS <br /> LAVAT04tt(WASM BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISP CLOTHES DRYERS <br /> DISMWASNER RANGE HOOD <br /> LAUN�RY TRAY WATER HEATER <br /> CIOTHES WASHER WOOD STOVE <br /> URINAL METALFIREPLACE(WO00 BURNING) <br /> DFINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKSLOW PREVENTERS GAS RANGE <br /> SINK�SEFlVICE—OAR.ETC.1 GAS PIPING <br /> E%HAUST FAN <br /> � SU6 TOTAL 5 SUB TOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> fPOfR<Elp>Glt PE�RSCI9ACR SIOESEtB�CN PUNLIIELMNUMB[fl FE�E RECE:1'iNJ <br /> �o s co� o�-oa <br /> useici.e �men e vr.cu+rsrte FEES VALUATION FEE <br /> F'i,=. �'f nves n rvo euaoixc <br /> neim�rur.ur. riooro.ccunr szeoro�oen <br /> orvns rw��ert+c <br /> Z � I O � �^ <br /> �OU����CY IpCVSICP�S CLCUMNlLOFO 9�SEIA[NL MECI4NIC0. <br /> I p [l YES ,NJ <br /> Fl� SVP�.tlRtClIPFOO RE>SON AUp�1pN4LPUNCIIECY <br /> N� OLNEF <br /> ���EPUii'.IPEOU RER50 — <br />' N J SieIEBUR��NGSUPCNMGE <br /> rvveorcor+si ru�� ar��oveoer CITVOFEVERETT weizwoeKs �,J <br /> !/ � I�"' LOCAL SALES <br /> ° � oq�� TAX CODE IS 3105 TOTAI <br />