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APPLICATI�.A FOR CONSTRUC7 .ON PERMIT <br /> CITY OF EVERETT• BUI�DING DIVISION � <br /> 3200 CEDAR STREET• EVERETT, WA 98201 •259-8810 <br /> I 1 DEMOLITION f I COMBINATION i i BUILDING ` MECHANICAL � ' PLUMBING f ! SIGN <br /> PROJECT AODRESS <br /> "3�3 �I . CA�N� �,� ��� _��,�(� �s- �� <br /> o�rrn r�.0 enonrss cirv r�r m�oNc <br /> r��NhC'�,� � � � 3�0� �r� �- a- 5��v{ 3�� - �3�q <br /> IfN11NT n �nnnrss nTr 7m rnor�F <br /> �f1C111ifCI0ROF510H[O M�II �f10��F55 GTY /IP 1`IIONF <br /> 6FNfRM f.ONLMCIOR M�q�DPt1f55 f1IV nr rnnvr FIAtf IICENFf• <br /> �MFC UNIUI CONTfI�f,lOn INAq�DpnF55 GTv )iP PiIONC i�if Uf(N5F� <br /> .na�-�..�C'�. i2z-r z„� A�� ►l. K�,.,r 9�� 5�5-s�ct� I �E,�,,ac �kar��rr <br /> PIIIMflMGf.ONIR�f,i(M MMI.ROUf1E55 CItY 71� PPONF $LF�FUCFNSF• <br /> CONTR�f,I PqiCF O!W(N1N <br /> �Z,� (v����,� HEATING SVSTEM: I �GAS � I ELECTRIC f I <br /> DFSCnIAF WOnN�ND SOUMF �OOt+GF INvo1vED CnNInC�ri nsO��nqp rnOvf ND <br /> ��E���+ux- -, evf` �� �✓Ic_1_�_A-,.1 3��-- 14.Sa <br /> �- <br /> � HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> rnyf�p,pousF ov pi i wa APPLICATION AND NNOW THE SAMF TO BE TRUE AND CORRECt ALl <br /> ��!,,� PROVISIONS OF LAWS AND ORDINANCES GOVEFiNING THIS TVPE OF <br /> _y.� ���� WORK WILI �E COMPLIED WItH WHETHER SFECIFIED FIEREIN OR <br /> iecaoescmm�or�ornaorennisr�ownec�owa�errne��iwoeories NOT. THE ORANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> LOi_ _PIOCN or AUTHORITV TO VIOLATE OF CANCEL THE PROVISION OF ANY <br /> OTHEF STATE OR LOCAL I.AW REGULATINO CONSTqUCTION JR THE <br /> PERFOPMANCE OF CONSiRUCTION.?HAT I AM AUTHORIZEO BV THE <br /> OWNER OF THIS PPOPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION I� COMPLV WIiH THE STATE <br /> r��ei ux i o �niMeen CON i NACTO� P CW AND 296.200 WAC. <br /> COYStR11CilON10�N1[NOGN.�OMiF55.TREPHONENVMPER x � � � S �" <br /> SICN�tURF U�O ��� ��IF <br /> f,l USMfS511CFN5f NO <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILET) � 1 A/C-AMNDLOUNITS-H.P. ' <br /> BATHTUB � FORCED AIR SVSTEMS-B.i.U. M E.A. i <br /> LAVATORV(WASH BASIN) I1EAT PUMP � <br /> SHOWER UNIT HEATERS-�T.U. M <br /> KITCHEN SINK 8 DISP CLOiHES DRVERS � <br /> �ISHWASHEP VENTILATION FAN i_ <br /> LAUNORV TRAV ; RANGE HO00 i _ <br /> CLOTHES WASHER i WATER HEATER <br /> URINAL ' WOOD STOVE i <br /> ORINKING FOUNTAIN METAL FIF7EPLACE(WOO��URNING) i <br /> FLOOR URAIN � FIREPL�CE INSERT(WOOD�URNING) ; <br /> BACHFLOW PREVENTERS � GASFIREPLACE i <br /> SINK(SERVICE-�AR, ETC.) GAS FANGE <br /> GAS PIPING ' <br /> i EXHAUST FAN � <br /> � 7� � S ' <br /> � � <br /> � ' <br /> SUBTOTAL E � SUBTOTAL S � <br /> PERMII $ --� PERMIT S � <br /> TOTAL FEE S � TOTAL FEE S O�O' � <br /> FOR OFFICE USE ONLY: <br /> rnoeTSFrpeeK ne�nsrTner.H smesrre�cK r�nr�airrxuuunrn/. rrr nrcnrrNo <br /> �Q� <br /> use¢orue �ar�nt• vec�Hi�nr FEES VALUAiION FEE <br /> — ----�_- <br /> iirr5 :�. tiu nm�n�Na ; <br /> IIE1611T U1,111�t10N NO O�UWFLUNG SIIF 0!Plf%i�l <br /> IMi15 PI IIMPIN(i � <br /> _—___ __ ___—.—.__ __ __—_'_}—_ <br /> OCCIIP�NCV 1M��1(IPN{5 IX:CII�RNIIO�p P�StA1FNi Nfl'IUNIUI (�}Q iQ� <br /> anour <br /> i i.rs �� vn - ----- -�----- --`�---�-—�_. <br /> i <br /> i <br /> nneannunFon nresnv enuniotieiri�mu�rcK � <br /> -- --- -----T--�- <br /> ou�rn i <br /> - - —_�_- <br /> nnvsrnwxiFnnrnn nrnsnv - — � <br /> srnrz nunnivr,sunumnae � <br /> ---'- ---��-- <br /> trreorr.oNsr - rinasnpimnvrnm CITYOFEVERETT �'�����r��•���i'�� � <br /> ,��1* LOCAL SALES -- - -- -- - ------ ------ - '--- <br /> ,.�„ � , �p .y� TAX CODE IS 3105 TorAL � <br /> --- --- - --- --- - - - _ _ -- -- - -- -'- - <br />