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APPLICATIO.. FOR CONSTRUCTI.�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT.WA 98201 •259-8810 <br /> ❑ DEMpUnpN ❑ COMBINATION ❑ BUILDnING t� MECHANICAL O PLUAABIN(i ❑ SIGH <br /> pROJECTADDRESS: �7� I �P'�r✓�Or e f��/'� <br /> urv Im P��Z�/� �7 / <br /> 01M1ER ( MIJI N)D11E.55 / ll c�.,l.) LO �n I(l �/. �. _ 7 G..(�l ) <br /> � ���,, � / Lc- Roo s A�e r � �� <br /> .LOlLSJL�, I�FG / G.5�i�2%� JV G� GTr na nar� <br /> TEMM�� � � MNlM10RF.'5J5, I , 1 .,n.. ��/�J J��/� <br /> NW VUS�IL/L� ��Jl (/�/e�l•KI�PACry� �VC7�•'i!J- 1`HONE <br /> �- w�n�Ttss 2z530 .5� Z��o�� Jf�1(..7p/�'lC�U�I! �o� y3c' � <br /> JAL� DC��IVF^�e'h'I — i��. / - P�� .+E 51AlElKENSE� <br /> MiYI MIN�E55 Cliv <br /> oEr�n.aMcw�.a/�croa /- p -. c�7 -��4 7 /Ct Y' )�ir/19EL I <br /> R�Q�i /'1L�t�"^(tl�o�I 19y30 (oSrhLluO 5a ��.C:�1�i 5v�-�— r�wue STQElCENSE� <br /> ran �:r <br /> �CONiR�CTOR MMlwuir.c�n - <br /> C'tt 71^- p�pNE STATEl1LEN5E� <br /> PLU��CON(R/�CIOR M�R/�OOAE55 <br /> `°"T"�`Tr�aw� -� ��J O� DO HEATINGSYSTEM: �GAS OELECTRIC ❑ - <br /> ��{ppl E MV 0 f.ON1�CT . SOM 11NtI PIIDHE NO Zo6 S 7 Z 73 9� <br /> o� ar � , - o , ( Sa <br /> • � ,, � <br /> n I HEREBY CERTIFY TH�? I HAVE READ AND EXIIM�NEO THIS <br /> . I '��� ��[j{^- APPLICATION AND KNOW THE S�ME TO BE TRUE AND CORRECT AlL <br /> �p�qn��p�q PROVISIONS OF LAWS AND ORDINANCES f30VERNING THIS T/PE OF <br /> q//.�.�� WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> C119' <br /> ��OE���P�EaTM��������n�N���s� AUTHORITYTO VOLATEAORRCANCEETNEP OVISON Of AINY <br /> �m eiocic � O7HER STATE OR LOC1LL LAW REOULATIN(�CONSTRUCTION OR TME <br /> PERfORMANCE OF CONSTRUCTION•71�AT I AM AUTTIOf11ZE0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TME WORK FOH WH�H <br /> APPLICIITION IS MADE AND I COMPLY WITH THE 3TATE <br /> CANTRACTORS lAW iB27 RCW AND 298200 WAC. <br /> ryq�EL TINI 10.MILlER <br /> �,�, , s-/7-9 <br /> ppHgiq��710N LOM�LENOER.�DM�CSS.TELEP11p/E MUMMER 61GNI11UIIE DI1TE <br /> an eus�r�ss i�c¢�sc ra <br /> �� MECHIINICIIL �E <br /> FEE NO. TrPEOFEWJIPMEMT <br /> NO. TYPE OF FlI(TUAE OR ITEM �_�NDL6 UNfT3 � <br /> WATER CLOSET(TOILET) , FORCED AIR SYSTEMS � <br /> BATFI1l1B � � <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> � UNIT HEATERS <br /> 6HOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK 6 DISP � qANGE HOOD � <br /> pISHWASMER � <br /> � WATER HEA7ER --i� <br /> UUNORY TRAY ' ' <br /> � WOODSTOVE � <br /> CLOTHES WASHER � p,�E7AL FIREPLACE(WOOD BURNING) <br /> URINAL � FIREPLACE INSERT(WOOD BURNING) ' <br /> DRINKINO FOUNTAIN ' ' <br /> , GAS flHEPLACE � <br /> FLOOR DRAIN i GAS RANGE ' <br /> BACKFLOW PREVENTERS ' ��p�pING <br /> SINK(SERVICE—BAR,ETC.) � �(HAUST FAN <br /> � <br /> � � <br /> , SUBTOTAL f � <br /> SUB TOTAL S i pERM1T s ' <br /> PERM�T ' � TOTAL FEE f ' <br /> TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: rEF r�r.riP*no <br /> 11E�RSETP�C1( SIOESETB�M 1'l�NC11F.C�%���• ' <br /> i110MT5ETB�ICK `7 �� <br /> FEES V�LUATION FEE <br /> USE tOME LOl ARE� ��CANT SIfE � <br /> ❑YES ❑�0 ��IIIIIIMO <br /> i <br /> 11EqNi IMAiAT10N NO OF DWELLIN6 SRE Oi BlD6Rl pl11MOM6 <br /> UN115 T <br /> i <br /> OCCUPMlLY Iq0�51pK5 OCGUPAMIIO�D B�SEMENi MFCIIneir,M —_ �— <br /> i <br /> 6ROlIF ❑YES ❑NO <br /> M)OI110N�1.Pt�N 06 f.Ic — <br /> �$PNINKLER REO'0 PFASON <br /> on¢n <br /> I <br /> FIREAUAMREO'D �E�G� St�1C�IP10�NG5URGlleflf,E � <br /> �' ��_ <br /> trceovca+s* rtnw5�rrnovEDer CITYOFEVEREIT rimiv.vrcm�s _i-- <br /> LOCAL SALES TOipL <br /> TAX CODE IS J/05 <br /> D�lE -' <br />