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APPLICATI� FOR CONSTRUC7�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •257-8870 <br /> ❑ DEMOLI110N ❑ COMBINATION Cl BUILDING R MECHANICAL ❑ PLUMBING i i SIGN <br /> PROJECT,pADDRESS p <br /> /��KG�D��I �03� ,6lONI�w+.. Lr[.a.r_.�f <br /> OW12P MuI�OG�l55 ' GiY ZG PNONE <br /> 1EY�Hf 4�4�WNC55 CItY ZiP PNOXE <br /> d's,��l/S <br /> I.�GNR[C1p1�L5GNlP YAR�WNF55 CItY IV PNONf. <br /> CCMIULLONfPAGLpR M4ll�E$$ LIIY SV I'110N[ $i1i[I�CCNS[• <br /> VECIIANiCALLOMR.�CtO�� M�IL�OCP65 OtY ZM RIq2 Si11EUCFNSE• <br /> !-�i�55/.YJ/�-un� 7.Z72 lSfiJuSoS.�a� `l8/00 ��o���6s-t.�rs/lwsr,WexiavTz <br /> i�u�ertmcorrta�cton uuiw�ncss utr zm mwr�e s*�rtiK[rvsc. <br /> coraN.c.onneorw«+K � s7 , o� HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑_ <br /> OCSCRi9C KGf1N�NO SGJ�Af IW fAG(IIN0.YE0 CON4CL fCP5p1�NO PNONE 1q <br /> I HEREOV CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br /> APPLICATION AND KNOY!TNE SAME TO OF TRUE AN�CORRECT ALL <br /> rnwrosEo USE or ew�ort� PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYfE OF <br /> WORK WILL BE C00.1PUED V/IiH WMETHER SPECIFIED HEPEIN OR <br /> imuceuax�iqNannw2nrvis�rownecioww+enecni»ncc=icsi NOT. h1E GRANTING OF A PEHMIT DOES NOT PRESUME -f0 GIV[ <br /> wr e�ocr, or AVTHO(iliY TO VIOLATE OR CANCEL THE PROVISIOh OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUGTiON OR THE <br /> PERFORMANCE OF CONSTRUCTION.1HAT I AM AVTMOH12ED OY TME <br /> OWNER OF TNIS PROPERTV TO PERFORM THE WOyK FOR WNICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE SiATE <br /> rnncutuior�uuecn CONTRqCTOR LAW1827RCWAN029fi.700WAC. <br /> � <br /> ccusrnucnonio�r��crmca.woncss.m[rr�wkxuuecu �9 ���4-�t `����� , <br /> xprvemn[ oe�! <br /> CRY OUSIf1E55lICO15C 1q <br /> PLUMBING MECNANICAL <br /> N0. TYPE OF FI%TURE ON ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER ClOSET(TOILET) A'C—AHNDLG UNITS <br /> BATHTUP FORCEDAIR SVS7EMS <br /> IAVATORV�WASH�FSIN) HEATPUMP � <br /> SNOWER � UNITHEFTERS <br /> NITCHEN SINK 8 OISP GLOTNES�fiYERS <br /> DISMWASHER PANGE HOOD <br /> LAUNORVTRAV WATERHEATER ' � <br /> CLOTMES WASHER I WOOD STOVE ' I <br /> URINA� � METALFIREFLACE�WOODOURNING� , <br /> DRI4KINGFOUIJTAIN i FIREPLACEINSEFTpY00�DURNINGI � <br /> FLCOR DRAIN GAS FIREPLALE <br /> DACNFL0IY PREVENTERS GAS RANGE <br /> SINN�SERVICE—BAR,ETC J GPS PIPINO <br /> E%MAUST FAN <br /> — r i'•ai <br /> SUBTOTAL S SUBTOTAL 5 <br /> PERh71T 5 PEPMIT 5 <br /> TOTALFEE S TOiALFEE 5 <br /> FOR OFFICE USE OIiLY: <br /> [ROII1yFipa:{ PC��SEt6MR Si�E5Ei0�LR VIAIICNEC6HJN8EB (EE �FCE�PfNO <br /> us[mrvs ior�uu v.uN�snc FEES VALUnTION FEE <br /> nns o xo �M1O� <br /> Ncw�rtuurt��roru rroam�tuina siicore�oc�i <br /> Uxi15 PlVuOi�q <br /> CCtlIP�HLY NOCf9�f5 CCN1?NiIOM O�Y4U1� MCCI4NCK <br /> GNp/P <br /> C]Y[5 ONO <br /> iR1E5MVMALPPCOO RUSCN �W�IqNALPUNCI�ECN <br /> OMCR <br /> imE�UWufOD PFA)GN <br /> 51�iE BOLLO�x6 SU�CNMGE <br /> trnror�o�+sr �1.r�s��veo�xoor �ITYOFEVEHETT rue��cwonxs ( <br /> LOCALSALES � <br /> o�ri TAX CODE IS 3105 TOT�L <br />