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APPLICATION FOR CONSTRUCTIMIN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8870 <br />❑ DEMOLITION <br />❑ COMBINATION <br />($ BUILDING <br />❑ MECHANICAL <br />0 PLUMBING ❑ SIGN <br />PROJECT ADDRESS: <br />9102 IgTid <br />AYE. <br />SE tYER6'Gfl <br />l✓A <br />_ 9e20R <br />E$Zkc, ENbwµp <br />IO41-1 4pTM <br />AJE <br />DJfRE'iAT' <br />0I1052D6 <br />OYINER <br />MMEAWIIESS <br />an <br />IR, <br />'NONE <br />USV4REST t✓lWclX <br />SIC 4co <br />(I a-(;* ^0- Re— t Leff <br />Bh.E1c jG 1i,L01k- <br />I-25. <br />4fo2 ' IAzS' _ <br />RFANL <br />MAIL AOpRESS <br />OrY <br />IN <br />RIONE <br />s,OO M41Ki.0SS L01b <br />2•ILTH <br />S'( 5EJ <br />LyNAlI1JQE0 <br />g602G <br />4tS'_ <br />LTo - P�65-I <br />ARl`ARr1CRMrER <br />"I ADDRESS <br />01, <br />.IT, <br />rI"F <br />F�L1L <br />_ <br />GENERAL CONrMCIDI <br />MAIL ADDRESS <br />OILY <br />Tr <br />mx},E <br />51GtE LICENSE r <br />07', LIP PRONE STATE LICENSE r <br />PIIIMRMGCONTRACTOP MAILADUSESS OR, IIP PROIF STAFF LICENSE <br />CONTRACT P1110E OF VgRA <br />4701600 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC Cl — Nr/� <br />DESC WBE MVRN ANU SQUARE rOOTAGE INVOLVED <br />0.1,1. P-aHJW nErl'C _i-A6 L £4N+Lr H��•A'f' FaP- <br />CONTACT KRSDI AM PHONE NO <br />(Y.4 W(aEL 6s s-rrO (Aet'(LHFUf No.•1`f'ao Tia <br />e*AAv. UNFE10 fOLE Sn •NU fVUl7 Z.io f•�t <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <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 LOCK LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF TH'; PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />COE{TRACT S LAIV IB.27 pCW A20O WPC <br />X I ti_ I/k 4, e/lrl9R <br />rro'DsfD usE or RnndNG <br />No dUIMJI�.I Pr -ANT- <br />LEGAL DrscvlrTroR vTRorEntt lsHorm AMW.A",,.5 wo CDPIEs <br />LOT BLOCK or <br />02 D.i a DO Oq <br />PAIICEL TAXI O NLRHEEn <br />CONSTRUCTIDN LOAN LfN[IFn. ADDRESS. TELFMONE MINTIER <br />SIGN�UR�DATE <br />- <br />01Y EASINESS LICENSE NO <br />PLUMBING <br />MECHANICAL _ <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —AVHNOLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />(AS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GLS PIPING <br />EX14AUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMITs <br />PERMITs <br />TOTALFEE $ <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />IRRNI VTFIACK <br />nrAn$r10ACA <br />SIDIFS[IRACK <br />PLAN CAECA NU R <br />Moo <br />if <br />f� off <br />RECEIPT NO <br />RISE ZCNF <br />IOF AREA <br />vACANI mR <br />❑rE5 ❑ NO <br />FEES <br />VALUATON <br />FEE <br />RIAIdNG <br />/ 5 - <br />IIEIGNT 11411AIION <br />NO DNF ERLUNG <br />I:NIIS <br />SITED RLDGnI 1 <br />r-TANNG <br />��G <br />—+— <br />OCCtMANCY <br />G110Ur <br />'�!5 <br />D'C.111`ANI IOAU <br />EAST RN <br />DIES ZNO <br />Mfl'HANICAI <br />Apoll(W.I. r'I A%. a,rcK <br />_ <br />EI E$IMI!a1Ln RE0n-- <br />JI <br />nFASM / <br />CITIES <br />I <br />FIRE ALAN. RFOD <br />40 <br />Sf A501 <br />/ oy7a <br />541E RIM EXNf. 511RUlARG[ <br />— <br />O <br />TrvEorC.OIISI <br />A <br />V V I <br />r1 nN5 Arrnrnty DDv <br />�L 1 /r% <br />DALE <br />CRY OF EVERETT <br />LOCAL SALES <br />TAT( CODE IS 7105 <br />MRX woos <br />` <br />TOTAL <br />- <br />2 <br />