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APPLICATI�1 FOR CONSTRUC�N PERMIT� <br /> CITY OF EVERETT•BUILDI�i DIVISION <br /> 3200 CEDAR STREET•EVERETT,Wr:98201 •257-8810 <br /> ❑ DEMOLITION G COMBIN�TION ❑ BUILDINO ❑ MECHIINICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS ' y' <br /> �>7G �,�lS��C.c/f� /���if1 L� j�jf�O/ �ZS�¢."8.✓Sl 5.91_ <br /> pm�c u.y o:wcss ! crtr iv aNac <br /> ���d��7 f,�-/f .����C�.��tay� .f��z�f �-�Q9�, yl�-�SZ�s 9� <br /> TEWYf IMR�OOIE66 i/ CIfY SO RqllE <br /> � V <br /> Jc7=T7'7—�• _ <br /> ♦RCIIIIEGidV0E6qKF MAllMIX1E56 CRY IF P1q14 <br /> GENEP�LCOHIR�ICTpi MA0.�D�f1[55 CItY ZP R10NE 6T/.iELiLENSF• <br /> iP�LI MMIf.p1C55 CRY IG R1pR ST�IEIICENSE• <br /> PLIIMBRqCCNfRACIOfl MI.RMDf1E55 GffY IF RpNE Si1iEl1LEN5E1 <br /> pRRACI PNCE � ` � HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OESCnIBE f1RNUN50u�AE�OS1Tl.0EIM/OLVEO � LONf/.CIFEPSpIM1NpPN[�Nflq. <br /> ��� / �7 <br /> / 1 <br /> ��G/L�'Pc-�>l--�CS _ .t� t C/ -fa-5 <br /> ./ I HEREBV CERTIFY THAT I MAVE REAO AND E%AMINED THIS <br /> ' � APPLICATON AND KNOW THE SAME TO BE TRIIE AND CORREC2 ALL <br /> oseu u a em�o�ry/��/� PpOVI51ON5 OF LAWS AND ORDINANCES GOVERNING THIS NPL OF <br /> �/��11 - / � � � WOFR WiLL OE f,OMPLIED WITH WHETNER SPEGFIED NER[IN OR <br /> iw�� qeciv�eM1 srqwHBEiononeTi ,n*wo Pq51 NOT. T71E GPANTING OF A PEFMIT DOES NOT ARESUME TO GIVE <br /> tor eiocN a AUTHORITV TO VIOUTE OR CANCEL THE PROVISION OF ANV <br /> OTHEH STATE OR LOCAL UW REGUTATING CONSTRUCTION OA THE <br /> PERFORMqNCE OF CONSTRUJTION.THAT 1 AM AUTHOHIZE�BY TME <br /> OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> vnnGE�tet iD.Nu�roEn CANTRRCTORS �N 1B i7 P '/AND 296200 WAC. <br /> CONSTFULTqNI!V.NlENO[N.�WqE65.lElGIM1MMENUMBEN '-•�i�' .�'� 'G'L� �D��Q-f.b <br /> X <br /> Sqx�UP[ DeiE <br /> CRT BIISME55 LiG[NSE 1b <br /> PLUMBINO MECM�NIC�L <br /> N0. TYPE OF FI%TUPE OR ITEM FEE NO. TYPE OF E011�PL1ENT FEE <br /> WATERClOSET(TOILET) i NC—MINDLGUNITS <br /> �ATHTUB ! FORCED AIR SYSTEMS <br /> LAVATORY(WASN BASIN) j HEAi�UMP � <br /> SNOWER j UNITHEATERS � <br /> KITCMEN SINR R DISP j CLOTHES DFYEPS <br /> DISHWASNER i RANGE F"N.1D <br /> LAUNuriY1HAY i WA7'ERH6.11ER � <br /> _ �_ <br /> CLOTN[5 wASNER WOOD STOVE , <br /> UFINAL � METALFIREPLACE�WOOD6URNING) ' <br /> DP'NKINGFOJNTAIN i fIREPLACEINSEFT(WOODDURNING) <br /> FLOOR ORAIN GAS FIREPLAGE <br /> �ACKFLOW PREVENTERS i GAS RhNGE <br /> SINK(SERVICE—BAR,ETC.� � GAS PIPING <br /> � E%HAUSTFAN <br /> i <br /> i <br /> — i <br /> SUBTOTAL E SUBTOtAL S i <br /> PERMIT 5 PERMIT S <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> flqNi:�iBACII PUPSET9�CN SI�F6FTBILN PIAHCNCtI(NUNBEq iEE �ECERiIq <br /> rn� - <br /> USEIONE �o*rnu wcu+tsirE FEES VALUATION PEE <br /> ❑rca o ra euaonq <br /> HEqMLIMrt�IICN IqOFpNELLIM� SIIECiBIMTI. <br /> UMi$ p�UM811p <br /> On��NLv WUi510iF5 OCLUPNIiIO�D BASEMEM uECn4ULAL <br /> ❑YE6 O�q <br /> i0iE51'PMRIFRREOD REASON '���kP��ECIt <br /> OTMER <br /> iHE�UPMPEOD PE�SOH <br /> ST�tE BUi1D�q SUPCNMGE <br /> ivreorwxsr. runs�wnovcoer CITYOFEYERETT ��G�+�s <br /> , LOCALSALES — <br /> D/.tE TAX CODE IS 3105 TOTM. <br />