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APPLICATIO� FOR CONSTRUCTL JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> . 3200 CEDAR STREET•EVERETT,WA 98201 •259-BB10 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDING p MECHANICAL �PLUMBING [7 SIGN <br /> PROJECTADDRESS: /_ oyZs ��k,_/�yE SF EL6r2�' LOT �4�IG �IS�3 <br /> OWNER MNLAOiN1E55 GITY IIP PIIONE <br /> �3�1�✓lkaiznH ,��aD �3..1e1at�/ez�i' n,.r,�ord__ 9��J.36 (za6)7A7-G7oo <br /> TENMIT MqL A/WqE55 f.I7Y 7ip p��pqE <br /> ��/� <br /> A 1ECT Oil DE5IGNER 11 �pppE55 CITY 711' P1pNE <br /> .�vo�� L.l��s l4/S yyl�;s�,� �re.e�__�03 3S3 -vS3( <br /> 6ENFfUIC,pNiMCTOi1 MMLADDRE55 GIY 7iP PIIONE SfATELICENSE� <br /> r�ilrrr..� Qae/�y �vn�iac� �2b'Jd �'� .)„ �q4, /� ,�� 96��3c (2dH 7�7-�7eC � /' G /�U.?Z= <br /> M�E WWICALCONTRIILTOR MML�ODHESS G�� )ip PIIONE AT�� <br />� G/lC�Yl�Cc� in�ir.fnrc 7 �r�,,y�..�'_3 7 F7 � <br /> ''9}/�'�,��o �t�Linc� lvr[� .l 9 6 E(201.) .Y') -�7UD FITF 6Q,TF <br />�� . PWMMMM+CONTRACTOR MMLADDpE55 GITY 11P PiKK+E STATELICENSE� <br />�'� �l/ P/l/Ni�n�.�r��s� S7/ i o� �l E !4 i N y <br /> CONTMCTFRIC OFWORK <br /> I S` HEATING SYSTEM: ❑GAS ❑ELECTpIC ❑ <br /> IoesenreewonK�r+o �:C r�o7 ave� U coe�u rens �Nor �/f.S� 7 _37- 1�7�3 <br /> /l � S 'C�- �1✓V4.�i ��7 ' 4,�IOCI <br /> CS.��''O_AQ `"Y�IO S �� I HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br /> � vnoroseo use ov euien o 7 � � APFLICATION AND KNOW THE SAME TO BE 7RUE AND rARREC7 AlL <br /> � la,� � PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br /> � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HENEIN OR <br /> iEc�o�s�nrTror+arnovE Is�owneEirn+oa�n�cN cawesl NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot y e�ocK oF AUTHORITY TO VIOLATE OH CANCEL THE PROVISION OF ANY <br /> ' OTHER S7ATE OR LOCAL LAW RE6UUTINO CONSTRUCTION OR THE <br /> S��y �IN 'I4 StP.I-�'.i ""r' • PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOAK FOR WHICH <br /> , _.� S� wrn .�.��d �� � ( APPUCATION IS MADE AND I COMPLY WI7H THE STATE <br /> PAqCEL Tl1%I.D.NIIMBER CONTRACiORS LAW 1827 RCW AND 298200 WqC. <br /> CONSiR11CTpN ldW�}.l,ENOEP. SS.TE/L�E E NUM 1 ./ x �y(�- �{V ��C/"'�" ��� I S Q� <br /> —Tf LYII 7 1 L✓�V�/ S,IY n SI RE DATE <br /> � �Z��Os� <br /> Cl/Y BUSINESS LICENS[NO. <br /> ����� MECHANICAI <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF F.p1NpMENT FEE <br /> WATER CLOSET(TOILEn � NC—NHNDL(i UNfT3 � <br /> BATHTUB ; FORCEDAIRSVSTEMS � <br /> LAVATORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS � <br /> KITCHEN SINK 8 OISP ; CLOTHES ORYERS ; <br /> DISHWASHER � RAN6E HOOD � . <br /> LAUNDRY TPAY ; WATER HEATER � <br /> � <br /> CIOTHES WASHER � WOOD STO� � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT pN000 BURNING) ; <br /> FLOOR DRAIN � GAS FIREPLACE '�— <br /> BACKFLOW PREVENTERS ; GASRAN�E ; <br /> SINK�SERVICE—BAR,ETC.) � G+S PIPING � � <br /> ' EXHtiUST FAN � <br /> � - <br /> � �_ <br /> i � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT t � <br /> TOTALFEE S � TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBIICK REM SET&1CK SIDE SFTB�CN J PIAN CIIECN NUMBfII / FEF RECEIPI NO <br /> D /o S 13-30 S <br /> useaor� -I toT�nen VACANISIfF. FEES VALUATION FEE <br /> [3 �O � res ❑ No nunnu+c ���' I D� <br /> MEIGHT LIMITA�p N NO OF DWELU $IZE OF BLDO?I � <br /> r/ uNits � Q676 tf. L�.ii�/4 t riuMnn�r, .j�;OD <br /> � B�b . ? GE <br /> OCCUPANCY NO Of SIONES OCCUPANT IOAD BASEMENf �—� <br /> a MFCII�NIf.M a (� i �J <br /> (2�y J-I Z ❑res o , <br /> FIRESPRINKLERREO'D RE�SON �OMIIpNRI.PL�NC��ff.N , i <br /> i <br /> on�rn � <br /> FlREAURMNEO'0 RF��ON <br /> � <br /> STn1Efl1111bIN1:511nf,HApOF L i S� <br /> � <br /> __ _' �._ <br /> rrveoFr.orJsr P(ANSAPPR�nar CITYOFEVEREIT runnr.wonKs _ -a�.J ; �.>;�_� <br /> � LOCAL SALES -�— <br /> -� oerE (O 30 �J6 TAx CODE IS 3105 roTAL I <br />