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� <br />APPLICATII.N FOR CONS7RUCi.ON PERMiT <br />CITY OF [VERETT • BUILDIIJG DIVISION � <br />3200 CEDAR STREET • EVFRETT, WA 90201 • 259•BR10 <br />f 1 DEMOLITION f 1 COMBINATION BUILDING i MECHANICAL �! pLUMBING f I SIGN <br />PROJECT ADDRESS , ,. ; , , � <br />owrven unn enoncsc �,i, r.r � r�or�c <br />,;�:,r..s , ."�.. <br />�;.�-=—r�.� ,t.S�%'J'14N'AUS� l"''_.Irc(t `�'d*J'Z J'�G_��'6/ <br />IENAHT �AAII.ApDI�E55 ---_'—'�- -cih ZiP PIIONE <br />I.IRIL ��ORE55 <br />GENEMLCONiMC10R M�IL��UP[55 CI1V JiP PIIONE STATELICENSE� <br />/17C� I = 4'iJ'- z 9y" Au SE /17��;' �r� �,C 5'��� L �%G •.fti ��1CS Dtr � p <br />MECHAHIWI CONiR/.CiOR MAII ADDPESS CIiY ZiP P110NE ST�IE LI�ENSF � <br />PLUMBIH6CONiRACTOR M0.1lA�DRE55 CILV 7iP PIIOHE STATEIICENSE� <br />PRICE OF WO(1N <br />�ESCPiBE W4AKAND SOl1ARE fppT�GE INVOlVEO <br />LEG�I [1ESCRIPTION OF PROPEAT' ISNOYM BEIOW OA /��RA'G�'1 <br />l0T ,� PLOLN Of�[� <br />PAACEITA%10 NUMBEfi <br />LONSTPUCTIONLO�NLEHOER.��DRESS,TELEPHONE NUMOER <br />F.l� a u`� r w r if r� n. >> F � Q� <br />_� S v <br />PLUMBING <br />N0. 1YPE OF FI%TURE OR ITEM <br />'Z WATER CLOSET ITOILETI <br />6'➢�CCj <br />i1:/S/ <br />OPINNING FOUNTAIN <br />FLOOR DRAIN <br />BACHFLOW PREVENTERS <br />SINK (SEHVICE — DAR, ETC. <br />HEATING SYSTEM: iR'GAS fl ELECTRIC rl <br />fO4inrr PF H°.Ov nNil rnoNE No <br />I NERE�Y CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TYPE OF <br />_— WORK Wlll �E COMPLIED WITH WHETHFR SPECIFIED HEREIN OR <br />rwocomEs NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM[ TO GIVE <br />fA,Q,C AUTHOf71TV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHEF STATE OR LOCAL LAW PEGULATING CONSTRUCTION OR TNE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM 4UTHORIZED BV THE <br />OWNER OF THIS PROPERTV 70 PERFORM THE WORK FOR WHICH <br />APPIICAT10N IS MADE AND I COMPIY WITH THE STAT[ <br />CONTFACTO 5 LAW i827 P.CW AND 296200 WAC. <br />6L-L ��.� - `!� - <br />;� s w � 5��. ,�, � o�.E <br />CITY ItU5ME55 LIC[NSE NO <br />MECHANICAL <br />FEE N0. TYPE OF FIXTl1RE OR ITEM <br />A/C — AMNDLG UNITS — H.P <br />—' FORCEDAIRSVSTEMS—B.TU. M EA. <br />� � HEAT NUMA <br />UNITHEATERS—BT.U. M <br />� CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (W000 BURNING) <br />� Finrni ncF iticFar rwnnn niintiitir.i <br />SUB TOTAL 5 <br />PERMIT S <br />l'OiALFEE ,S <br />FOR OFFICE USE ONLY: <br />fRONTSET[V1CM RC�I1SFipACK <br />'Zi� �� O <br />U5E2oNE� Lot�nF• <br />_� / - <br />L7 <br />IIEIGNTUMITATION NO O� OWfIUNG <br />� � �rturs <br />OCCUPAHCV 1p O�SipaiES OCCUP�NIl04� <br />FlREAU�MREOD �fi[�SON <br />srniNKien <br />'N <br />cif' SELB�CN <br />ya�urt �:n <br />F� . <br />szeoi mucii <br />� 8 SF l�vi��4 } <br />I:AM �.:. <br />pASEMENi <br />�[5 10 <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE IS 9105 <br />GAS FIREPL <br />GASRANGE <br />��� <br />PERMIT 5 � <br />TOTAL FEE S ! <br />,; , � / <br />rlMlc��[CKNIIMnFn � rEF� PP[[�r1No . <br />•��.� r� ' � � � � � � � - `� <br />nunri�+c (� Z S �' � I �- <br />; — <br />riu�enn�, �. - I ,-,. , <br />M[C11AryIGL � � <br />RDDIfiONAL PIAry (;NECK � <br />_ _�_' <br />Ot1�f11 <br />1 <br />srnir ounumc suna�enac ; _ <br />� <br />rueucwonKs . � <br />I <br />TOTAI � I � <br />