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APPLICATIQ1 FOR CONSTRUC100N PERMIT <br />CITY OF EVERETT K BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA OB201 • 259•0010 <br />❑ DEMOLITION Cl COMBINATION fl BUILDING ❑ MECHANICAL Fl PLUMBING n SIGN <br />PROJECT ADDRESS <br />sGS 2� �yEP1�� E�J wki rcygL zL"T 96203 <br />OWNLn uuu00nESS CITY ZIP PIIONE <br />KLClTtwwlEr" (!potS <br />TENANT uA1I.AOO11E55 <br />CITY <br />ZIP <br />PHONE <br />QlC(r( ROg GLAR1:DD5 i)i-)r!VE <br />(74V4-W WAY[CVC1LCtC 98 Zo3 <br />AP UTECT On OESIGIICD YAILADORC55 <br />CITY <br />3eDz <br />ZIP <br />MIO11E <br />fZo6GKTw.eHA+1PLo►JAP�II <br />vie �vwe�if <br />(4ZZ25`i-31'SL <br />IIi-7 <br />GENEMLCOONISACTOn YALADDDESS <br />CITY <br />ZIP <br />PNONc <br />STAIEtIC[NSE. <br />MECIWnCY C0N111AC1W IMRADOREss <br />19T38 <br />PITY <br />- 1.44F<vC <br />SIP <br />PIIDN6 <br />STATE LICENSE. <br />P,DVR1.Ir,EZ �IK.G �'KeiLL(LeL1 <br />u wOI1.NILL.E <br />(4254E+3-5(�ri7 POVAf1FP 194 66 <br />PLUUUwOCannACIPIT uAILADOPESS <br />CITY <br />ZIP <br />+.CITE <br />STATE ❑CENSE. <br />coNIlTAcrrrvcL OPTwITK <br />HEATINGSYSTEM: []GAS fl ELECTRIC fl <br />�ESCNDE Wang ANp:AIIMCroorw[urvOLvm •� - <br />�JRuT IH Vi-_LlU- :INStitL(.t�'C1oN E��io$PC. <br />Canec l rOLan ANn P'lour No <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOVI THE SAME TO DE TRUE AND CORRECT. ALL <br />PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTh: R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT: AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA CTO-7RCW AND 29G.200 WAC. <br />91 - 9 - <br />X <br />rnoKTSEO usE or omc0wa <br />UWALOESCTIPTICN Or WIOPEnTY 15110. OELOW On ATTACII WMCORES) <br />LOTCLOCK <br />rulC[L:AA LO.Im.IDEryr <br />Co1157RUCnon LOAN I.EuE n. ADOPESS. vUENIOnEwuocn <br />SIGIu 1 I <br />(, <br />OAT" <br />CITY uUwIESS LICENSE no <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AIHNOLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M EA. <br />LnVATORY (WASH BASIN) <br />HEAT PUMP <br />ShOWER <br />UNIT HEATERS—D.T.V. M <br />KITCHEN SINK E OISP <br />CLOTHES DRYERS <br />DISHWASHER <br />VENTILATION FAN <br />LAUNDRYTRAY <br />RANGE HCOD <br />CLOTHES WASHER <br />WATER HEATER <br />i— <br />URINAL <br />WOOD STOVE <br />DRINKING FOUNTAIN <br />METAL FIREPLACE (WOOD BURNING) <br />FLOOR DRAIN <br />FIPEPLACE INSERT (WOOD BURNING) <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />�— <br />SINK (SERVICE —OAR. ETC.) <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT f <br />TOTALFEE $1 <br />TOTAIFEE S <br />�Y�7iL4dy[9X1Iy�7�14A <br />TROUT SEIDACK <br />PEAT SEtTTACK <br />SOT SrlO.•Cn <br />run cuCU nvuorn <br />/c y'9o� - CV-7Y3. <br />ITT <br />as <br />n¢uri NO <br />USE ZONE <br />LOI AREA <br />vACNn WE <br />FEES <br />VALUATION <br />FEE <br />auLOP,r. <br />r_ <br />n rrs IT No <br />IICIGIII OWTAtION <br />NO OF OWELWIG <br />SIZEOTCLLIGRI <br />Urals <br />RUuoINO <br />I <br />I PNOr 1 10 IN SIN.LS <br />GnOUP <br />OCCUPAIIT LOAD <br />DASCUENT <br />NCCIIRICAL <br />errs n N0 <br />AOP TONAL MAN C11ECA <br />ME ALANA nEOD <br />REASON <br />ODRn <br />ME SPPP.Ut. "TOP <br />nEA5UI <br />STATE DUILDVIO SIIPCI W1GE <br />TYPE Of T.a6T <br />rw¢u+rllp Dr <br />DATE % %� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />ruovr..vonKS <br />�- — <br />TOTAL <br />