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�� <br /> - -_._ <br /> � <br /> APPLICATIO^ : FOR CONSTRUCT►.iN PEi;MIT <br />` CITY OF EVERETT• BUILDING DIVISI^N <br /> 3200 CEDAR STREET• EVEREIT,WA 98201 • (425)257-8810 <br /> I ❑ '1EMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL C PLUMBINO ❑ SIGN <br /> PROJECTADDRESS: �G '� /%-9�"H ,^i �t /=✓�R.-'7� 14i!! J.¢�,,� <br />' /�Y�/�'Y fJ. J'l'l`'!°C,EL.(�9N �-vP/?fiT 1u�1 O b'' �5.ri /01�/O <br /> I MUL�0011k55 LITY =ip P1qNE <br /> 7EN�Ni M11q��{1F.55 GTY )IP VIqNF <br /> �t1CNITfCTOAbE51GHE� M��I�OD�E55 [iIY nr � rv�or�p <br />� GFNEf1�l CpNilIACTd1 M�II�WRE55 [�IV )iP pilfy�l. 51�fL IiCI'NSF� <br /> MF.CNANIC�If.ONTR�CIOP MAII�W�E55 CT� )iP pppr�f SI�fFLICENSE� <br /> PIUMBMGCON7R�Ci0R M��1�00RE55 CITY pIP PMUNF STAfFIIGENSF• <br />� LONfMCI PPoCE O�W0111t <br /> HEATIN(i SYSTEM: ■ GAS ❑ ELECTRIC ❑ <br /> OFSCNIOF WORN�NO 5'JU�11E FOpt11GE MVOIVED CONT1Cf�fR50N�Nf11'H(kIF NO <br /> �lYS' %, �.0 Ac'h'�'/'CN! 3�u �� /'ii"G /- ���t i?Y yll�'��,G.Cdir ��✓r5 �9.�/� <br /> I /{� 'F %� [=� s' //,�c" - <br /> I HEREBV CERIIFV THAT I HAVE READ ANO EXAMINED THIS <br /> Pnorosco use av emi.pr�o APPLICATION AND KNOW THE SAME TO 9[TRUE AND CORHECT qLL <br /> PPOVISIONS OF IAWS ANJ ORUiNANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPiIED W'IiH WHETHEH SPECIFIEO HEREIN OR <br /> LEO�LDESCRmnONO�P[IpPERfV151qWNPELOWON�TT�CHTW0001'IE51 NOT. THE GNANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> irn _ eioce or_ AUTHORITV TO VIOLATE UR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAI.LAW REOUTATINO CONSiRUCTION OR THE <br /> , PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV THE <br /> — OWNEF OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICqTION IS MADE AkD 1 COMPIV WITH THE STATE <br />, PMCEI Uk I D MIAIBEB CONTRACTORS LAW 1B 27 RCW AND 296?00 WAC. <br /> CONSiR11C!I(NI IO�N IEN!]FR A(f011E55.TEIEPNONE NWPFR x��f� �� �C(��C��� <br /> SIGN�IURE D�t( <br /> CITY BUSINESS IICF N5C NO <br /> � _ <br /> � PWMBIN6 MECHANICAL <br /> � NO. TYPE OF FlXTURE OR REM FEE NO. TVPE OF EOUIPMEN� FEE <br /> ' WATER CLOSET(TOILET) � A/C—A/HNDLO UNRS � <br /> BATHTUB ; FORCED AIR SVSTEMS <br /> LAVAtORV(WASN BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATERS <br /> KITCHEN SINK d DISP ; CLOTIIES DRVFRS ; <br /> DISHWASNER � RANC.E HOOD <br /> LAUNDRY TRAV � WATER HEATER � <br /> CLOTNES WASHER WOUD STOVE T- <br /> 1 URINAt METAL FIREPLACE(WOOD BURNING) � <br /> r — DRINNINa FOUNTAIN ; FIPEPLACE INSERT(lNOOD BURNING) i_ <br />� FLOOR DRAIN � GAS FIREPLACE <br />� BACKFLOW PREVENTERS � GAS RANGE ; <br /> SINK(SERVICE—BAR,ETC.) GAS PIPINCa �— <br /> II EXHAUSTfAN �_ <br />� — i i <br /> SUB TOTAL S 1 SUB TOTAL f ; <br /> PERMiT f � PERMIT f —T— <br /> ?OTAL FEE f TOTAL FEE f <br /> FOR OFFICE USE ONLY: <br /> 111(1Ni5Rp�fk 11fAf15i1B�f.0 S�OESFfB�CN P��NCIiECNNUMBfR �EF �FfFIPtNO <br /> ..�C(' ���i. <br /> use 1or�r ioi�ne� v�e�rn srte FEES VI IUATION FEE <br /> ❑rE5 ❑ NO flIMIA�Nf. '— '_ "—r_.- <br /> HFIOHt I IMII�IIOH NO 0�pWELLING SIIE M OIOG�II —'— ----'- — �-- <br /> ������ PI�IMPiNO <br /> � <br /> _____-_._ _"-....___ " _ ____'_�+__. _ <br /> IX:GIPe41:r NOrnc�nnil� PdCu1MN11D�D B�ciMEN� Mif.NeNlf.q <br /> f R011P <br /> ❑YES ❑NO '-__ _____ "._'_-. ___ _. <br /> IIRFSN�INKlE11HEQ'D �h�SfN� �DD�hONqfIAN��d.tk <br /> _� _ "__ _ ---- ___ � __ ' <br /> OI1�E� ' <br /> _ � <br /> RpCA1APMREQ'0 RMSOV '— ' --' <br /> 51�if fluilUM�i SUnC1I�Oft[ <br /> trrt or coycr--� r�nr�5�nrnovFnar CITY dF EVEiiETT r�inucvrcinxc j <br /> LOCAL SALES - — – — -- —---'– -- <br /> _ __ ,,.;f TAX CODE IS 3105 TOTaI_ _ <br />