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�-3 <br />RE <br />APPLICATION FOR CONSTRUC*ION PERMIT{/!//����� <br />CITY OF EVERETT • BUILDING DIVISION \� <br />3200 CEDAR STREET • EVERETT, WA 98201 P257-8810 <br />DEMOLITION COMBINATION G BUILDING ❑ MECHANICAL G PLUMBING G SIGN <br />PROJECT ADDRESS <br />A •dP Mu1: L0. WEiS Y+CITYY V Im e(Lv1/G✓/�YPIro1E �V <br />02 WEB pc <br />i7cI Z C?6INo 3tq 5. fl��% toµ ON WA <br />TEI..T VUL AODPESS CITY ZIP PHSIE <br />qq;n }Eit OR OESC✓4F 441 ACO'IESS IT I, '-'• <br />-5aa7FLe WA �18134 ?ova//�2? -87j <br />RUUBCG CO,f! KTDA ,kcADDFESS C',lY ZP PnJNE STATE UCENSEA <br />CONTi4CT RICE OF y'wy,T�l <br />D/SOIJ{ <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />CESAnCRIBE w AAND E FOOTAGE 011OLWO <br />(E.T,sr:61-u,.roewr�,-rar�+-UF�s��e.�U. <br />CCI.Tu:T PERSON NW PNCNE 14 <br />T <br />r Sr� <br />"" <br />1 <br />OW TTO I.9 • <br />lw,gm�120 Mal -55 L <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED <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 />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 />CONTRACTORS LAW 18.27 RCW AND 296200 WAG. <br />X <br />vRDPOssD u,t DF ea¢ •.; <br />j�INI-c�.SINo <br />ItOU CESCRYt✓MI OF PPOPERTY 1 N 148ELOWCRARACNTVOCDPIE51 <br />LOT &OWc OF <br />PueEL TAx ID xuM,ER <br />COISTP TON LOANtEI✓pEP. ADORES,. iElEPNUIIE tauBEP <br />s`,,ATuFf I - /5o�23" DATE <br />CITY 61&SS LKENSEI <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AID—A'HNDLG UNITS <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />i <br />SHOWER <br />i <br />UNIT HEATERS <br />j <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />i <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WA6HER <br />WOOD STOVE <br />i <br />URINAL <br />i <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR ETC.) <br />OAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />j <br />PERMIT s <br />PERMIT S <br />TOTAL FEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: -,,LA !'S'; r.2—b-;0 Vol. V <br />FP ll SEiIIACK <br />PEAR SCTBACA <br />SEE%T,ACR <br />NCNELK. <br />NUMu,ER <br />W <br />FEE. /JiJ <br />7�— <br />RECEIPT NO <br />USEZaIL., n <br />t/K - <br />LOT APEA <br />vALANr SITE <br />O n, D w <br />FEES <br />VALUATION <br />FEE <br />&lllDlltl <br />O < Z <br />y <br />NEIONT IWRAi[MT <br />NK LF ON£LLllp <br />,IZE CF NOG•FI <br />1111896 <br />Ruu,um <br />:CY W a STFFES <br />Al Z <br />OGCUFAIR LOAD <br />2 1 T <br />SEMEN' <br />❑ns <br />uECl1AlIICK <br />AODITp11ALPWICNECK <br />`% <br />0 <br />FFEAMER MOD <br />PEA,ON <br />INAEALPAIKOD <br />J <br />REAS n <br />STATE BUPDA14 SUNLNMGE <br />TYPE Of ST <br />-I OR W/SPM1A4(4. <br />EL.—C ikliLiq R <br />PWIS APP D,r <br />DL'E <br />CI?Y OF EVERETT <br />LG AL SALES <br />TAX CODE IS 3105 <br />Mm YroR.s <br />TOTAL <br />/ <br />■ <br />2,D VIA) yb <br />