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APPLICATI+�.1 FO� CONSTRUCT. )N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 00201 • 259•8810 <br />O DEMOUTION ❑ COMBINATION ❑ BUILDING [�MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: ' � ! �/ �— <br />�-�- .� -�<_-�tt���__ 1�;,�---��----- 3y8 ' y��� <br />��E A�+n � I uAu � u� ' � i� - !�i i i�i <br />�-�--�5�1 ��_��K�f"11Kt j.�� Sly __ C.����" I � �'1���i -- <br />��M� <br />RICHR(CTIXIpE51GNf� M�pAbM1E55 LiIY �--�-_)m....----- P�HMd --- <br />uui eamcss <br />_"_ __. . _-- _ <br />�Ci�I�Y��� � i...- P�qNF SI�IC IICCNSE • <br />�11�-1�1_ -��.--� �l�r.o /��.cT/li,r/H/l�,�_ <br />urv nr v�oar SIQF I�CENSE . <br />PWMBWGCON1RAf,fq1 M4l�WRE55 ���CIIY 711' PIqN[ S1A1E��CENSE• <br />GONTRki VqICE 0i VIOIIM "— — <br />� � '� � � -- HEATING SYSTEM: �FJ GAS ❑ ELECTRIC ❑ <br />pESGRIlE YA7fIM �ND SW11FE fOOl�OE INVOIVEp co��uc� rr nsa� um r��arc Hu <br />iAl��ac� ,=-C, Fuo.���� �.O,n.�.�-n <br />vllpiq5[D u5E O� BVIldNO <br />iea�� oescmrriw or� rnorEnn �s�roww aciow a+�rt�cn iwo cov�cs� <br />LOT _ _ eIOCN Of _ <br />T/JI 1 D. MIMBER <br />ca�srnucriorr iou� iENoen, <br />NO. TYPE OF FlI(TURE OR ITEM <br />WATER CIOSET (TOILET) <br />BATHTUB <br />UVAIORV (WASH BASINI <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />UUNDRV TRAV <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />f110NT5E7RACN Rfe115FiP�Ck SIOESFTP�[.k <br />USE Zd/F <br />NF�6NT IIMIUTI(NI <br />ona v�Ncv ru [ <br />{'Inf SPNNHLERRE( <br />i iNl . IARM REO'0 <br />1 rP{ O! f.pNSf <br />IOI�RF• <br />NO Oi OW[ILiNG <br />IINIIC <br />PI�NS <br />V�C�NI Slif <br />❑YFS <br />S�IE Of Bl W /11 <br />�u��, iv�.�BK�� 3'.��Z�`U <br />I HEHEBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION ANO KNOW THE SAME TO UE TRUE AND CORRECT ALL <br />PfiOVISIONS UF LAWS AND ORDINAr:CES GOVERNING THIS TVPE OF <br />WORH WIIL OE COMPLIED WITH WHETHER SPECIFIEO HEREIN (�N <br />NOT. fHE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTIIER STATE OR LOCAL LAW REGUUTINO CONSTRUCTION OR THE <br />PEFlFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />GWNER OF TIi1S PROPERTV 10 PERFORM THE WORK FOR WHIC/1 <br />APPLICATION IS MAD AN ., COMPIV WITH THE STATE <br />CONTRACTORS LAW 27 q 2g6200 WAC. <br />/ <br />x_ �� � — <br />s�nN�rune o�t <br />CITY BUSMF.55 LIC[NS[ Iq <br />FEE NO. TYPE OFE06 <br />� A/C—AMNDLQUNRS <br />; FORCEDAIRSYSTEMS <br />i HEAT PUMP <br />UNIT HEATERS <br />; CLOTHES DRVERS <br />MNGE HOOD <br />� WAT[R HFATER <br />� WO00 STOVE <br />� ME�AL FIREPLACL (N'Of <br />; FIHEPIACEINSERT�WO <br />� GAS FIR[PLACE <br />� GASRANG[ <br />��— GAS PIPINC <br />, FXHAUSTFAN <br />n�r+c�rtc�Nuuxvn rtr <br />FEES __ _ <br />❑ �o nimnwn <br />❑YF$ ❑ HO <br />CITV OF EVERETT <br />LOCALSALES <br />TAX CODE I5 3105 <br />rv i �unw , <br />MI [u�Ni11M <br />�f�lliliON�1 Pl�af.illGh <br />onnn <br />SUIE fl1I111LN(i SU�f,IUfMF <br />rum u� w' m. c <br />TOTAL <br />SUB TOTAL f <br />PERMIT S <br />TOTAL FEE f <br />nFcrm�wo <br />