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APPLICATIO■� FOR CONSTRUCTION PERMIT <br /> CITY OF EVEFETT• BUILDING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259•8010 <br /> ❑ DEMOLITION ❑ COMBINATION P� BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS: 3�� 3 W� Cy-5 in/a /�-� �O-3Z <br /> `130EiNc.� P. d. oX 3'7v7 M S off-/_Z SEft.i� t✓�', 9,��zy <br /> ��/Ea� M�ILADOIIF55 Gltt IO' p110NE <br /> L7�/I`�6. <br /> TFNNI� YqIM)Oqf55 GfY 71P PUONE <br /> _ �¢-vsr��i � <br /> Ai1CItlTCCT011DE51GHER MM111[ORE55 CIIY )n� PNpNE <br /> �'lJ.ST/� / <br /> OENEIUIGONIfUCfdl MNlADD0E55 C�IY )iP PUONE SI�TEIICENSE� <br /> MFCNIJIKALCONiR�LI011 MALADORE55 f.IIY )IP PNONF SU�EUCENSE� <br /> PlU1MN6CONIRACfOR M�iI�DORE55 CIfY IIP PIqHE <br /> STA7E UCENSE� <br /> COHf1UCt PItl�E OF WIXII( <br /> HEATING SVSTEM: ❑GAS ❑ELECTRIC ❑ <br /> �FSGRIlE WJfIK�Iq SqJARE F0p1�pE IHVOlVEO f,ONIA�I P[I150NAN0 VNd1E Iq <br /> C�L6�T� M !/c.Ti C.EV6'�- Oltf-(C-E LFONA�LJ /'75P'�'�Y7'iBe/CSK� 2L6-��� <br /> S 14G E O O 5�' I HEHEBV CERTIFV THAT I HAVE READ AND E%AMINEO THIS <br /> tto U5e or i�dr�o APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT All <br /> OICC /%GG PROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS 7'!PE OF <br /> 1E011L0E5LPoPtIONpf%Ipp(Ptt�51qWNBFlOWIX1ATTFCN7Vp�pp�ES� �'ti'ORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T ���� � AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTMER STA7E OR LOCAL LAW qE6UUTINO CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAi I AM AUiHORIZED BV THE ' � <br /> OWNER OF THIS PHOPERTY TO PERFORM THE WURK FOR WHICH ' <br /> APPLICATION IS MADE ANO I COMPLV WITH THE STATE ����Y�'.�, <br /> wwce�mc i.o.ruwern CONTRA/Q TORS LAW 18.27 RCW AND 296.200 W//AC. �� <br /> CUMSfRUC110NlONllENOER.�DD11E55.fE1E1'11d1ENWpE11 x Ci� z�A . "� '� ` ////9/� <br /> SqN�fUNE �' DAfE <br /> LITY BUSME55 LICFNSE NO <br /> PLUIMINfi MECHANICAL <br /> M0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF pqUIPMENT FEE <br /> WATER CIOSET(TOILEn � NC—AMNOL�UNff3 , <br /> BATHTUB ' FORCEDAIRSVSTEMS � <br /> � <br /> UVATORY(WASH BASIN) � HEAT PUMP <br /> SHOWER ' <br /> ' UNIT HEATEHS i <br /> KITCNEN SINK 8 DISP i CLOTHES ORYERS <br /> OISHWASHER ' <br /> ' RANOEHOOD <br /> UUNDRY TRAY � ' <br /> � WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> � <br /> URINAL � METAL FIREPIACE(WOOD BURNINO) �— <br /> DqINKINO FOUNTAIN ; FIREPLACE INSEIif(WOOD BURNINO) <br /> FLOOR DRAIN ' <br /> I . ' GAS FIREPIACE , <br /> f BACKFLOW PREVENTERS � GAS RANGE � <br />'. SINK(SEHVICE—BAR,ETC J � GAS PIPINQ � <br />� � <br /> ' EXHi.USTFAN � <br /> rt <br /> � <br />' � <br /> � <br /> it � <br /> i — � � <br /> � <br /> SUB TOTAL f ' SUB TOTAL f � <br /> PERMIT S r PERMIT S , <br /> TOTAL FEE f � TOTAL FEE f � <br /> FOR OFFICE USE ONLY: ' <br /> if10MT SFTEACI( R[�R SETBA�N SIDE SETB�CK ��AN CIIELk NUMBFII fEf RFf.EIPt NO <br /> .�.�:.'�� <br /> USEIONE IOtAREA V�CI1NfyfE FEES VALUATION FEE <br /> OYES O NO T <br /> — OIMIOM(i �y/�/) J <br /> HEIOHfIIM/AfION NOpipW(LLIIq 51IEOF6LOOlf1 ��W <br /> UHlft <br /> � U 000 PlUM0�N0 � <br /> O�CCUPANCI' Iq IX SIMff OCCUP�Nf�O�D B�SEI.1ENf ""� ' <br /> MECN�MC�I <br /> � b ❑res ❑Hn ' <br /> � <br /> fiqE6%tlMQEflREO'0 HE�SON �ppI110N�1MM1C11fCN P/_/1 ' �O <br /> (t S rr (oC/ p <br /> FlRE MREO'U pF�S� 0111E11 � <br /> / i <br /> \jy�I $i�1E01111UIN6511fIC11qi6F i � <br /> rrvEar,oasr cinNs�crn X¢pex ��yOFEVERE7i runucwona �� <br /> I I - (J ��~ LOCAL SALES � <br /> o•�t I -1�'4� TAX CODE IS 3105 TOTAL --I— <br />