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APPLICATI� FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT•BUII.DING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98207•257-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING YJ MECNANICAL �LUMBING ❑ SIGN <br /> PROJECTADDRE <br /> L 7` ZlI� <br /> �q �,�•�3 O c� z2 E '7`� C!� . �ZO/ <br /> a L <br /> ,�.�,� ,,,�,�ss ��,. :� <br /> �� �d[�'f� ,�/ ,oU � d � rd ��Z�/�1LJ'3� <br /> cn E..�V� 84NER MM�Wf665 I CRl' Ii {m0�1[ // <br /> riCUCfl4COHfMCl011 M/JLMpESE GIY $P MOMF SI�iELICENSE� <br /> I�ECruNiC4CONfRI.'T011 44MMEb5 GIT ii pqlk Si�tEL�LExSE• <br /> f'LViAOiNGLPrtMLT011 WLI➢PE58 Liry IN AIpE 6TAiElIL[H9E• <br /> COMnK1MGEOi WOIw HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> OESCAIBENq1Y.l E]VUIEfWfb X1V0.VEO f:qlfKiP <br /> � .� � � y2 r- s - z <br /> C > l y� <br /> I MEPEBV CERTIFY 7HAT I HAVE PEAD AND EXAIdINED TMIS <br /> APPUCATION ANO NNOI'/TNL SAME TO BE TRUE AND CORRECT.ALL <br /> raono;c occ a ou�mmc pqOVISI0N5 OF LAWS AND ORDINANCES GOV[RNINu THIS TVPE OF <br /> C I G � WORK WILL BE COldPLIED WITH WHETHER SPEpFlED HEFEIN OR <br /> �[wioewnwrqnovmovFnrv�swx+,ec� o �new ocv[61 NOi. THE G�ANTING OF A PERMIT DOEu NOT PRESU1d[ TO GIVE <br /> �n &out or AUTMORI7V TO VIOLATE ON CANGEL TI/E PROVISION OF ANY <br /> OTHER SiATE OP IOCAL LAW REGl1lATING CONSTRUCTION Oti TNE <br /> PEPFOR1dANCE OF CONSTRUCTION.THAT I AM AUTXORIZED�Y TME <br /> OWNEfl OG THIS PROP@RTY TO PERFOflM THE WORK FOR 'NHICII <br /> APPLILATION I� MAUE ND COMPLY WITN TNE STATL <br /> renc[�1�vi0ml4eEn WNTfiAG10 5 IB2] 029fi.200WAC. <br /> COii:iPVClAMl041LE14ER.Af.Of1E69.lElFRq12M1YBEN z �� .. 3 �V� <br /> sww*un o+i� <br /> �RY BUTn256 4LEu5[Np <br /> PLUMBING MECNf NICAL <br /> N0. TYPE OF FI%TUflE Ofl ITEM FEE N0. TVPE OF EOl11PMENT FEE <br /> WPTER OLOSET(TOILET) WC—A'HNDt G U1JIT5 <br /> �ATHTUB ! FURCEDAIRSYSTEMS � <br /> � LAVATORV(WASN BASIN) � MEAT PUIdP i <br /> SI/DWER UNIT HEATER; i <br /> Y.ITCNEN SINN 6 DISP � GLOiNES DNYERS <br /> � DISHWASNER t qANGENWD <br /> LAl1NDRYTRAY � WATERHEATER <br /> CLOTM[5 WASNER WOpp STOVE <br /> URINAL � METALFlR6PLAGE�WOODDURNING) <br /> �RINKING FOIINTAIN I FIREPLFC[INSERT pY00�OURNING) j <br /> FLOOR OPAI�� GAS FIREPIAGE <br /> BACKFLOW PREVENTER9 �AS RANGE <br /> S�NK(SERVICE—BAR,ETQ) ' GASPIPMG <br /> � E%NAUSTFAN ! <br /> i <br /> i <br /> SUBTOTAL f � SUBTOTAL S <br /> PERMIT E i PEPMIT S <br /> TOTALFEE f i TOTALFEE S <br /> FOR OFFICE USE ONLY: � -�Q a <br /> inUrt5Ef8�Cx PE/.N6Ff6liCl( 610ESET8I�CM IMNLNEGNMNIOEN fEF R[CEMivO <br /> use:a�c �ora+[e wcu�r6ire FEES VAWATiDN FEE <br /> ❑YE9 ❑1q BUM1d1q <br /> HEIONiLINRI.iqN IppipA(LLllp 61ZEOf61➢6rt1. <br /> UNI�6 PILWIN6 <br /> G.CUP4ICV NOO461p9E! OCCIRANiION BASEYEM NECNWKK <br /> OPWi <br /> ❑YES ONO <br /> imESPRMx�[RNEOD HEASON MJiiWNKPU4q1EClf <br /> OtNEA <br /> i�E�lAPM11E09 NEA50X <br /> SIAIE BWLOMq$UPCNFRGE <br /> irrsorcoHsr rv.Hs�wrro�,toer GTVOFEVERETT ruaz�cwouxs <br /> . LOCALSALES <br /> o�.c TAX CODE IS 3105 TO7AL <br />