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APPLICATI� FOR CONSTRUCT�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259•9810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �6AECHANICAL ❑ PLUMBINO O SION <br /> PROJECT ADDRESS: /`� �/�5�- ������ <br /> —�d��, S2/ L!/�e�$1C .Sa.afS�i� Gl�i�P- �5��-7� ( � <br /> OwMEn uenenpnEss c�rv �m <br /> � �IION <br /> —._�a�r,�> <br /> TEN�NT MML�f10nf55 faTY 11P PIqHE <br /> A1ILMTEGTd10E510NER M�I111D011E55 CIi'/ !�i` PIpNE <br /> .Dn�.� .���1�,� 7��= 9s�a� <br /> OEHEn4� ft iML10R M��II ADOnE55 cllY /� lm PIqNE St�fE LICENSE� <br /> /�fGR-�2s�rLs Tee � ��( /Z 6 � c�f��p r o ti l!/k 8�31-s°7 /�E�Tlh`�1�O o <br /> VECNAMC�l�ON7R�C10A u�il�DIX1E55 f.ltt IIP PnONE ST�iEII�ENSE� <br /> PLU4111NOCONIR�CIOR M�IUOD11E55 LIfY l�P P11pr1E ST�IEIICENSE� <br /> ��d0 <br /> ca,nucrrmceor r <br /> HEATING SYSTEM: ❑GAS ❑ ELECTHIC ❑ <br /> DESCRIlE NDRK I1N0 SW�Af,i00T�0E�NVOIVED f.ONf�GT PCf150N A110 PNpNE 1p <br /> .�e�t.�f . <br /> i 6i. .Ue �e <br /> �Q� 1 HEREOY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> rrroros¢ s¢or eu ara APPLICA710N AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS�ND ORDINANCES GOVEHNINO THIS TYPE OF <br /> WOHK WILL BE COMPLIFD WITH WHETHER SPECIFIED HEREIN OR <br /> LE00.0ESCNIPTIONOiPROPERTY�51qWNBElOwp1�TT�G117WpCOPIES� NOT. THE aRANTINO OF A PERMIT DOES NOT PRESUME TO QIVE <br /> �oT eia:� or AUTHORITY 70 VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOUTATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TME <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PMCEI TM 1 D.NUMBER CONTRACTORS LAW iB.27 RCW AND 298.200 WAC. <br /> /328/��'- / - OS3 -c�Dd � ,/ <br /> GONSiRUCT10NlOANIENDE11.1100NE55.TEIEI'NONE NUMBEII x���j�!b�// (�(�(�/ � �z <br /> SIOH�iURE 7 � o E 9G <br /> � <br /> CiTY BUSINESS LICENSE NO <br /> PLUMBINO MECHANICAL '� <br /> NO. TYPE OF FIIRURE OR ITEM FEE NO. 7YPE OF EOUIPMENT FEE <br /> _ WATEH CLOSET(TOILET) � NC-1VHNDLa UNRS �'— <br /> _ BATHTUB � FORCEDAIRSYSTEMS ' <br /> i <br /> IAVAI'ORY(WASH BASIN) � HEAT PUMP , <br /> SHOWER � UNIT HEATEPS � <br /> KITCHEN SINK 8 OISP ; CLOTHES DRYERS � <br /> DISHW�SHER � RANOENOOD � <br /> LAUNDRY TRAV ; WATER HEATEH � <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL � M[TAL FIREPLACE(WOOD BURNING) ' <br /> DRINNIN6 FOUNTAIN ; FIREPLACE INSERT(YYOOD BURNING) � <br /> FLOOR DRAIN � GAS FIP[PLACE � <br /> BACKFLOW PREVENTERS ; GAS RANGE ' <br /> � <br /> SINK(SERVICE—f9AR,ETC.) � GAS PIPINQ , <br /> ' EXHAUSTFAN � <br /> � , <br /> � � <br /> SUB TOTAL f ' SUBTOTAL S � <br /> PERMIT f � PERMIT f /� � � <br /> TOTAL FEE f � TOTAL FEE f ' <br /> FOR OFFICE USE ONLY: <br /> iRONTSETBACI( RE�RSFip�Clt S�DESFiBACK PUNG11ECkNUMpf11 � fEF PFf.FIPiNO <br /> l�= � <br /> u8E lor/F iOr enee veeeN�srte FE 5 VAIUATION FEE <br /> ❑res ❑ rro ouioiNn � <br /> � <br /> NEIONTLIMITATION NO O�DWELUNQ 51lE 01 BIpORI � <br /> UNIfF p�p40iNO � <br /> OLGUV�NCY Iq d SIMtlFS OCCUP�NILO�D B�SEMENf i <br /> ORWP wFGUNiUI i <br /> ❑YES O M� — <br /> fIRESPPiNKLERREO'0 �F�SOr1 <br /> •ObiilOH�1.Pl�N CnfCK ' <br /> _�__ <br /> Oi11E0 � <br /> RREAIMMREO'0 AfeSan _ — <br /> r <br /> STAI[OUIlO�Nf SIII1CIUpOE <br /> i <br /> __" �_ <br /> trv¢orr.or15r rinNsenrnov[oer CITYOFEVERETT runucwonMp <br /> LOCAL SALES — —�— <br /> o�rc TAI( CODE IS J105 TO7AL <br />