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APPLICATIO� FOR CONSTEiUCT�N PERMIT <br />" CITY OF EVERETT•BUILDING OIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •258•8810 . � <br /> ❑ DEMOLITION C] COMBINATION ❑ BUILDING �] MECFfANICAL ❑ PLUMBING O SIGN <br /> PRWECTADDRESS:���I1G / /{�` /-�✓E St � � <br /> ovn�a wu��oor+ess arv tm vNoae �7 <br /> ��Cl�� JO!-�/JSO/J �I SCi� ��11�/a-VE SC C✓C�''Er �J`'JL'a,i� `�J7 / �`�7i <br /> 7E/MNT 4NLIIOOi1E55 GTY IIP PIqNE <br /> MCNTECTOROESIGHEP M/uIMONE55 CItY /ll` PIIONE <br /> GENEMlIXN1IMtTOfi MN1A0011E55 LIIY 711' Pi10NE Sf�TEIICk`!SE• <br /> H�t�NE�/ COti'����G�ON /7iS /Ov%NP[ `� C✓�E'��T �BZa� <br /> MECH�NIC/�LCONTRAC70R IMIL�DORE55 fAIY ZiP D110NE STATEIILENSE� <br /> �5� <br /> PlU4BINGCONTRACiOR MIuI�DOf1E55 CIIY ZIP PIqNE STATEIICEN5E1 <br /> CONTMCTP(MVE'�WnOi1N <br /> �.� � HEATING SYSTEM: �GAS ❑ E�ECTRIC ❑ <br /> OEBGNE YIOtIN AND SOU�RE FOOTi1(iE WVOWED CONIACf PERSON NID PIIIX�E Np. <br /> If�KiAzc(1)7s,ooa r TGl. niA�-GA-S Fd2NnCC � ��2�� I ( � <br /> W�TN :� ToN A"IC UNi'r5 <br /> I HEREBY CERTIFY THAT I HAVE HEAD AND E%AMINEO THIS <br /> waroseo use oF euaara APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> CQMM�CI kL U r�C� C�('L`f.� CO,� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TY'PE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HERElN OR <br /> �auoescnwr�odorvnorenTv�sNowne¢�owan�n�cNrxocories� NOT. THE ORANTIN6 OF A PERMIT DOES NOT PRESUI�.U. TO GIVE <br /> �01 e�ocK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6UlATINCi CONSTRUCTION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV'FHE <br /> OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WHICH <br /> APPLICATIUN IS MADE AND I COMPLV WITH TMF STAfE <br /> PARLEL Uuf I.D.MIMBER CONTRACTORS LAW 1B27 ACW M�"-286200 WAC. <br /> ��sGp.�/-/�L9 �/ /9 <br /> CONSTNUCiIONLOANLENOEN.ADDPESS.TELEPNOMENU4lER SN/�11 P � �`-- � � <br /> 1r� DATE <br /> ' qTY BUSINESS lCENSC N0. <br /> PLUMBIN6 MECHANICAI <br /> � N0. TYPE OF FlXTURE OH ITEY FEE N0. 7YPE OF EGUIPMENT FEE <br /> WATEH CLOSET(TOILET) � NC—MiNDLd UNfTS ' <br /> BATHTUB ; 2. FORCED AIR SVSTEMS ; . <br /> LAVATORY(WASH BASIN) i HEAT PUMP � .. <br /> SFIOWER ' UNIT HEATERS ; <br /> KITCHEN SINK 8 DISP � CLOTHES DRYERS � - <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRV TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOODSTOVE � �� <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) i ' <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR.ETC.) � 2 GAS PIPING � I <br /> � EJ(HAUST FAN ' �� <br /> i <br /> � � <br /> � � <br /> ' � — <br /> � � <br /> SUB TOTAL S ' SUB TOTAL f ; <br /> PERMIT S � PERMIT f <br /> TOTALFEE S ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FIqHTSETBALI( MEM75ET&�CN SIOESFTB�CN PlANG11CC.KNUYBff1 FEF AEGE�P�NO <br /> uSEioNE �O�u+E� ��GNf51tE FEES VALUATIOH FEE <br /> UYGS ❑ NO BItlIOMG 1 <br /> — � <br /> MEIGNT 11MITATION NO Of OWELLIN6 SIIE Of BL061f.1 � � <br /> UNIIS P�IIMOIN(1 � <br /> __".�� T <br /> OCCUPANCY Iq OiSI0Wf5 OCCUPANTLOsO B�SEMENT MFC11er�iCAL � <br /> 01101N <br /> ❑YES ❑NO ' <br /> NEASQN ADIMLONM.PI< .N . i <br /> FqiE SPRINI(LEfl flE0'D — <br /> _— i <br /> 011lf i. � <br /> � <br /> FIPEIIMMREO'D NE�Sp1 � <br /> STAIEBUII� .IUORE i <br /> T <br /> fYPEOFf,ONSf PLANSAPPPOVEOBY CITYOFEVEREIT MIBIIf,W01 � <br /> LOCAL SALES ��� <br /> o�TE TAX CODE IS 9105 TOTAL � <br />