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APPLICATIO�r FOR CONSTRUCTMM�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISIOh <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 . � <br /> ❑ DEAAOUTION ❑ COMBINATION O BUILDING �1 MECHANICAL ❑ PlUM81NG ❑ SIGN <br /> q . <br /> PRWECTADDRESS: IG�I�Q I lf�` A✓E SE <br /> OM/ER MNLI100RE55 utt zm v� <br /> RrCl��i�1� Jo�,us�� 9sc� i,{��-vE sC cv�c-rs ��z� ��7-i��z . <br /> 7EWWT YI�IL�WRESS GTY I�P PIqNE <br /> NCN7ECT OR DESIGNER IAAII MONE55 GIIY /ll' P1pNE ' <br /> pENEMlGq1TMCfOR /Mil�Wi1E55 CIfV 711' PIqNE Sf�TEIICFNSE� <br /> ��/'rFr.vE�/ CouS�'�G%7cn� /7iS �co%H�'� �� �✓�'�T �Sz�' <br /> MECHANIGILCONTMCiOR IMitADDRE55 GTY 21P PNONE STATEIICENSE� <br /> E51 _ <br /> PLUYBMM.CGNTRACTOR YIuI�NORE55 CItY Iln PIqNE ST�7ELKENSE• <br /> caNrrucr vwcE a wonu <br /> < �.J � HEATING SYSTEM: �1,GAS O ELECTHIC ❑ <br /> l��(1�7S Gao�7TG(voweA-�'C/�. FrJ�/J/tC r CONT�Cf PEN50N ANU P110NE N0 C L J�_J' I , r <br /> `t <br /> irH ,3 ToN l�lC uN i Ts <br /> I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION P.NO KNOW THE SAME TO BE TRUE ANC CORRECT AlL <br /> w+ocoseo usc a euupra PR6VISIONS OF LAWS AND ORDINANCES GOVERNING TFiIS TYPE OF <br /> (�QMMERC1kLO �CC�� CESC�JIt) C��� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> �oKoescwarroNavroaEAnls�awnnEion'on�TT�cHiwocovies� NpT. THE ORANTINO Of A PERMIT DOES NOT PRESUME TO GIVE <br /> �07 e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AMY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUGTION.THAl'I AM AUTMORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFURM �r1E WORK FOR WMICH <br /> APPLICATION IS N.ADE AND I COMPLY WITH THE STATE <br /> v�nce�i�i.0.Mw�a CANTRACTORS LAW 1B27 RCW ANO 296200 WAC. <br /> 7 /� <br /> CONSTP.IICTIONLON/lENOER.A0011E55.TELEN/0NEMIMBER ���� (�J/� /9 <br /> 51 7U �-'...-� DAIE 1 � <br /> ' CITY BUSINESS IICENSC NO. <br /> PLUMBINO MECIiANICAL <br /> NO. TYPE OF fl%TURE OR fTCM FEE NO. IYPE OF ECUIPMENT FEE <br /> . WATER CLOSET(TOILET) � Z NC—AMNDLG UNRS _ ' <br /> 8/1fHTUB ; Z, FORCEDAIRSYSTEMS ; _ <br /> LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNIT HEATERS ; <br /> KITCHEN SINK 8 OISP � CLOTHES DRVERS � <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPIACE INSERT(WOOD BURNING) i <br /> FLOOR DRAIN � GAS FIREPLACE ' <br /> BACKFLOW PREVENTERS ; GAS RM1GE � <br /> SINK�SERVICE—BAR.ETC.) � 2 GAS PIPING � <br /> � EXHAUST FAN ' <br /> i ' <br /> � � <br /> i � <br /> � <br /> � � <br /> SUB TOT/l'. S ' SUf3 TOTAL f ; <br /> PERMIT S � PERMIT S <br /> TOTALFEE S ' TOTALFEE f , <br /> FOR OFFICE USE ONLY: <br /> iROHT5E7B�LN NEMSET&1CN SIOESFT&1CN PlANG11CC.NNIIMBff1 FEF REf.EIPINO <br /> u5E 20NE lOI�RE� v�Cu��site FEES VALUATION FEE <br /> 'T <br /> ❑Y[5 C NO � <br /> BUIIUMG <br /> 11EIGH7lIMlT�TIp! NO Of DWELIINb SIIEOi&Odfl � �— � <br /> UNIIS PUIMOINO — � <br /> __ <br /> Q�CU�Y MO Oi 51(MYES OCCUPANi lOAO BASEMENf MFCM�NICM. � <br /> ❑YES ❑NO — ' <br /> � <br /> FIBESPRIMILEflflEO'D RF�SON �INNIi.:»ul PV M . _ <br /> _. � <br /> 011I[� <br /> FIiIEMAfiMRE�'D RF�SON � <br /> ST�IEBUIIi �IUOGE � <br /> —_ r— <br /> rrvear,or+sr PLnNSd'PROVEDBY CITYOFEVERETT ruei�r.vroi � <br /> LOCAL SALES —'-`— <br /> OAIE TA%CODE IS 3105 TOTAL � <br />