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APPLICATIO.. FOR CONSTRUCTI.IN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION p�B.�.UJ�ILD/INJ�G� ❑ IWECHANICAL ❑ PWMBMG ❑ SIGN I <br /> PHWECT ADDRESS: �D(D�O — �`1" "���. <br /> pWNEq MNlI�00RE5S CITY 21P PMpNE / <br /> /�,�2�Lo� fC��P/e2- <3 7- 0 3 2 s <br /> 3719 /eP�`5 S� �v eT�e-f� u�f►-,�� 9�2 0 8 <br /> 11RLMTEGTOROESIGNER tWL�00RE55 CtIY T�P PMONE <br /> 6ENEfUL CONTMGTOR IWL 55 CITY IIP P110NE SUTE UCENSE� <br /> .�c5 �owr��s' iizo"� sE ���.�� Si�a� � z Sc�S �0 4SSm�i <br /> MEp1AWGiLCONTRACTOR MNL WORE55 CITY ;y`_� � PYIONE STATE LICENSE� <br /> i <br /> �n � <br /> PLUMBMMCONTRACTOR MAIL�WRESS Cltt ZIP PHONE STATEIICENSE� <br /> CpNTMCT ViMCE OF MIORK <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC O <br /> pE Wpllf AND$pIIME FOOTA6E WVOWED CONTIIGT PERSON ANO PIqNE NO <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> °�������"� PROVISIONS OF UWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �a�oEsc�aarqwprrnorEnrr�s�rovme�ow �rt�cxiwoco�e51 NOT. THE OHANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ;m_ s�� � AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br /> PERPORMANCE OF CONSTqUCTION.THAT I AM AUTHOfiIZEO BV THE <br /> OWNEH OF THIS PROPERTY TO PERFORM TME WOHK FOR WHICH <br /> APPLICATION IS MA�E AND I OMPIY WITH THE STATE <br /> v�tT�z�.o. � _ _ —I CANTRACTOPS�1B27FC AN 296200WAC. <br /> CONSiHUCT10NldWLENOER.�DIMIESS.IELEP110NEM1MEER � > � � � �i�. <br /> Af OATE <br /> pTY BUSINESS IICENSE NO. <br /> p�py�Np MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPMIENT FEE <br /> WATER CLOSET(TOILEn � NC—AMNDLCi UNfTS ' <br /> g,�,7►{T�g ; FORCED AIR SYSTEMS ; <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> �{pyyEp � UNIT HEATERS ' <br /> � KITCHEN SINK 8 DISP i CLOTHES DRVERS i <br /> � OISHWASHER � RAN(iE HOOD ' <br /> � LAUNDRY TRAY ; WATER HEATER � <br /> CLO'fHES WASHER � WOODSTOVE � <br /> URINAL ' MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKIN6 FOUNTAIN i FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DHAIN � GAS FIREPIACE ' <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING � <br /> � IXHAUST FAN ' <br /> � <br /> � � <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S � PERMIT f � <br /> TOTALFEE S ' TOTALfEE S ' <br /> FOR OFFICE USE ONIY: <br /> FIIONT SETBALK REM SEiBACN SIOE SETBnCN PL1W CIIECK NUAIBEP fEF AECEIPT NO <br /> useione ior�ae� v�cu+rsire FEES VAIUATION FEE <br /> i <br /> ❑YES ❑NO BIHLDINC � <br /> MEIONTLIMTIITION NOOFOWELUNO SIZEOfeLDGR.I � <br /> � <br /> UNITS p���Mg�ry� � <br /> OCCU��Y NO Of SIptlES OLCUP�NT LOAD B�SE�AENT � � <br /> d MECH�NIC�L i <br /> ❑YES 0 NO � <br /> FlPESPNKKLEflREO'D AEASON �DD�110N�L�UNCNF.C1c � <br /> i <br /> OTNER i <br /> flflEAIMMHEO'D REASCN � <br /> STqE BWLDINC SURCN�RGE � <br /> TYPEOFf,pNST Pl�NSMPROVEOBY CITYOFEVERETT �1�611f.WpRKS —j— <br /> LOCAL SALES � <br /> o�tE TAX CODE IS 9105 TOTAL � <br />