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APPLICATI�..� FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION O/ BUILDING ❑ MECHAN`ICAL �pLUMBING ❑ SIGN <br /> PROJECT ADDRESS:_ „2�� � Cv�6c,____�}t Stil (� 3cc� <br /> . <br /> ONMER /M�I�ADpqnE55 ��T• <br /> Y�-[ / Y A 1' // C {/�` I�r rNonE <br /> IENMlT MNLA / � S�G� ZJCIL// /1 �!J ��;WY <br /> �C <br /> �..//^ CITY I1P PIqNE <br /> � �RC DESIGNEFI A�^�`. r�. �� ��n, <br /> �� ..7P` 71P PMONE <br /> ( <br /> GENERAICqAMCiOfI MAILA�ppE55 GfY jip PiIONG Sf�i[pCFNSE� <br /> MECH�NICA�CONTRApTOR MAILADDRE55 dTY pIP PIIONE STATEIILENSE� <br /> MUMBMGCONiR�CTOR M�ILADDqE55 CIIY ZIP PNONE <br /> /� _ / /J/ N / . J y c STAiE LICENSE� <br /> ��'flYf 1/ 1 Sv,a �. (-�/23e3Q <br /> GONTMCfPPoGEOFWp11!( y�o s- zs� <br /> /OGD "� HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> UES�CPoBE MNiiR I1ND SOVARE FppT�E INVD�VEO CONfACT�f.RSpl�AN�PHONE NO <br /> � �/'� s��- y�3� <br /> I HEHEBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF&nL r�c APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br /> Q �y�* PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> lECM0E5CMPT10NpF�ryqpEp7y�5�qNR�gE�pWpp�nM•H�yroCOPIES) WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OH <br /> �or BLOCN oF AUTHOR TV TOTVIOLATEAOR CANCE ETHE PROVISION OF AINY <br /> OTHER STATE OR LOCAL LAW REODUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> wwcel r�x i.o.rnn�e¢q CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTHVCTIONIOANLENOER.�DORE55.TELEP110NENUMBER x_ �7j}�9 � �,j/f� �� _y J� <br /> SIGNIITUP O�TE <br /> CITY BUSINESS 110EN5F NO <br /> PLUMBINO MECNANICAL <br /> NO. TYpE OF FlI(TURE OR ITEM FEE NO. TYPE OF EpU1PMEHT FEE <br /> WATER CLOSET(TOILET) � NC—/VF{NDL(3 UNfTS , <br /> BATHTUB ' FORCEDAIRSYSTEMS � <br /> � <br /> UVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATERS � <br /> ��ITCHEN SINK E DISP i CLOTHES DRVERS ' <br /> DISHWASHER ' <br /> � RANGEHOOD , <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE , <br /> URINAL � MEfAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPLACE � <br /> BACKFLOW PREVENTERS ; GASRANGE � <br /> SINK(SERVICE—BAR,ETC.) � GAS PIPING , <br /> ' EXHAUSTFAN � <br /> i <br /> i <br /> � : <br /> i � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> . PERMIT S � PERMIT f � <br /> TOTAL FEE S � TOTAI FEE E <br /> FOR OFFICE USE ONLY: � <br /> FRdlT SETB�CN PEAp SET911LN SIDE SEiB�CR P(�N CIIECK NUMfl[R fEF RCf.EIPT NO <br /> uSEtor�E IOTAREl1 y��ANfSIIE FEES VAIUATION FEE <br /> ❑res ❑r+o ounniNr. � <br /> � <br /> HEIONT LIMITATIOH NO OF OWEIUNO SIIE OF BIOG?I <br /> UNIIS <br /> PlU1MING � <br /> O�U�IINC—rT�ikS OCCUPANTLO�D BASEMENT MECIInNI��� � <br /> � <br /> I ❑YES ❑NO <br /> FIREePRINKIERREO'O REASON �DDIiION�LPUNCIIECN i <br /> i <br /> '—T— <br /> 0111Ef1 � <br /> FIRE AIMM PEO'D REASd1 � <br /> STA7E OOqDINf SIIf1CH�OfE � <br /> rrvear.or+st rtnNS�rrnovEoev CITYOFEVERETT ri:qiir.wonKS ' <br /> LOCAL SALES — _j__ <br /> o�re TAX CODE IS�105 TOTAL <br />