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APPLICATIO11 FOR CONSTRUCTAN PERMIT <br />CITY OF EVERETT •BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •258-8010 <br />DEMOLITION ❑fqJC��OMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ BNiN <br />ADDRESS: 4•?-415 Rucker Ave <br />E6-4643 <br />n YYl AoollEss Howe <br />Clinic 4201 Rucker Ave, Ste 200 Everett WA 425-339-5409 <br />YkYI YM MRIE55 f.IIY /rn ryplR <br />iLCi pI pFSGMq YYI /J.'pgfyS Cln )II• n,Qn( <br />qµ CpNlNClpl M4l AppK55 LILY )II• n1"NF F111E lICFNM• <br />rK. neFrV Cmmpany s005 3rd AVe S Seattle WA 98106 206-762-3311 <br />411CMCCNTR•Iflli YIJI MgIE55 nn SMIEIK{NSFI <br />MMO CCNiq•CIM YYl4Wgf 55 On llr ngNF SMIF IKfMSE• <br />MCI PPICf Cf WOn11 <br />HEATING SYSTEM: ❑GAS DIELECTRIC ❑ <br />swl•E YqM ANp SwAgf rOC1AOE rrv0.NEP cEaucl rtnsnN ANq nroNE Nq <br />a Soto 425-641-2127 <br />I HEREOY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Pq�' $Ell uLE Of IIROINO <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT All <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />APigIfIf P110PEgn 151•TMI IEIOW UR M1K11 iMO CpYF51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />.14�_xocK 022 p_South Park Additl TS�UTIIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />t0 Everett replot blcks 19-2R, blck 0 ..QpTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />WERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PAllcEIm LEL NIA�Fq CONTRACTORS LAWS IB 27 �RCW AND 296.200 WAC. <br />11111CTKN l JM1lfM[IEq. WpIf55.lf IFRKInE MlYliq <br />SKINM1gF � MIFI <br />[IIY gVSHFSS IKFYSE NJ <br />SING MECHANICAL <br />TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EO IW%WAT FEE <br />WATER CLOSET (TC'LET) A/C—AMMDLG UNITS <br />BATHTUB FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) HEAT PUMP <br />SHOWER _UNIT HEATERS <br />KITCHEN SINK A DISP CLOTHES DRYERS <br />DISHWA;NER RANGE MOOD <br />LAUNDRY TRAY WATER HEATER <br />CLOTHES WASHER WOOD STOVE <br />URINAL METAL FIREPLACE MOOD BURNING) <br />DRINKING FOUNTAIN _ FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN GAS FIREPLACE <br />SACKFLOW PREVENTLRS GAS RANGE <br />SINK (SERVICE — BAR, ETC) OAS PIPING <br />_ EXHAUST FAN <br />Inergen System <br />SUBTOTAL S SUBTOTAL, f <br />PERMIT f PERMIT f <br />TOTAL FEE f TOTAL FEE f <br />OFFICE USE USE ONLY-. <br />WTWM g.Sf7 Ck S.msr,w. NA. CI qfk MMFq fFf P(fFRIM <br />El <br />W <br />0m <br />IE <br />M M <br />M F <br />M <br />YF I <br />nu <br />CONI <br />i� <br />E0 <br />lu* <br />ca H <br />❑YES ❑ Iq BUlll•IM1 <br />M bRPwfllllp SII OE0.W/11 <br />UIIIS M1INnNn <br />V 5IME5 I WCVPSNI IO•q EMEVEMI VECIIIJM.4 <br />• IM.I n ANCIKCK <br />0111En <br />STAY MnIp11fI51X1f.MM[ <br />CITY OF EVERETT nEKl. MI <br />LOCAL SALES — <br />TAX CODE IS 3105 TOTAL <br />