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APPLICATI�1 FOR CONSTRUC7�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT.WA 98201 •257•BB10 <br /> � DEMOLITION ❑ COMBINATION ❑ BUILDIN� ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRES � // / <br /> �.<�C.To �-^-• <br /> OWNER M�RAp011E55 ��ry Ip A�rt <br /> �$L,a,�,a ���4i S�•� �,� 2� � y'�s,zs$-n�� <br /> TENI.NT M/.R�DDR[55 ��N 1� %�E <br /> ARLNR6tOPM5GNEP M�4AOOPE55 PiY IG P110M[ <br /> Gy�CRqWNiRALipP 4�RAWF[55 LIfY 2P 1`IqNE SU¢IILENSE� <br /> C 'A E�'�r.l �...,7�R�t.�T� �� <br /> 1.�{.L XAN�CRCO e M�RI.DDULS$ GiY ZW RqNE Si�iEL�CCN$Ei <br /> PllIMOiNGCONiMCIOR u�R�DDRE55 CIiV Zi MKIN[ SUiELICCNSk• <br /> CON1P�CiPPILtOi\Y(MR HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> D ��B[WORKAHOSOUMEf00i�GEiHJ0.KD COxiKIVER50N�1N1YKK2M� <br /> I NERE�Y �ERTIFY THAT 1 MAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> rroaoseo us[or eunrnr+a pqOVI510N5 OF LAWS AND ORDIN:.NGES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH'NHETNcR SPECIFIEO MEREIN OR <br /> iccaoeunir.anaanovcntt�s�rowxaciowa+uuceiwocw+csi NOT. iHE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �or��II13 o�aK �� e7. 2 AUTMOPITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL UW PEGULATING LONSTPUCTION OR TME <br /> R a�be S W. PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY TME <br /> �—�' OWNER OF THI$PROPERTV TO PERFORM TME WORK FOR WMICH <br /> O�3 APPI�CAT ON MA ANO I COAIPLY WITM THE STATE <br /> r.ncc�rnxio�uasn CONTR O 27 WAN��AC. <br /> 3� o�i o� , G <br /> LOuSiRULPOtrtO/.NLENDE4AppnE55.1E1[PHONEMIMBER X �+ � <br /> $K�N� [ UI.iE <br /> CIIY BUSMES$lIC[NSE tA <br /> PLUMBING MECHANILRL <br /> NO. TVVE OF fl%TUPE OR ITEM FEE NO. TYPE OF EOUIGMENT FEE <br /> WATER CLOSET ROILET) A�'C—A'HNDLG UNRS <br /> BATHTUB ! FOPCEDAIRSYSTEMS <br /> �AVATORV(WASH BASIN) HEAT PUMP ! <br /> SHOWER i UNITHEATERS � <br /> KITCHEN SINK d DISP CLOTMES DFYERS <br /> �ISMWASHER RANGE HOOD <br /> IAUNDRY TRAV WATER HEAiER <br /> CLOTMES WASMER i WWD STOVE <br /> URINAL METAL FIFEPLALE(WOOD BURNING) <br /> DFINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> pACNFLOW PREVENTERS GAS RANGE <br /> SINK�SERVICE—BAR.ETC.) GAS PIPING � <br /> E%HAUSTFAN � <br /> i <br /> SUBiOTAL S SUOTOTAL 5 <br /> PERMIT 5 � PERMIT 5 <br /> TOTA�FEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> fPOYiSE18ACF �EAPSEiBACN SIOESEiBALK RAMCNCLNNUMBW �EE P[CflWlq <br /> l7C`C�-CO <br /> usczonc wrwu ��cwrsne FEES V�LU�TION FEE <br /> ❑YCS ❑NO WRp1q <br /> I�EIGMLPAVf�ipN NOCiON[LL:N1 SQEOF&OGTI <br /> IINIiS pIUMBiIq <br /> CLNo.V1LY 1qCf5iLP(5 OLCW�NtIOM B�YHENi MECNANGµ -� <br /> crow ��5 �� <br /> ApDiiqN.LLPtNICNCCK <br /> fIPE51'NiHRLCflRE00 AE�SON <br /> OiNEP I <br /> iIRC�UR4RE0� PGSON <br /> SL�LE BUM1�ItG$U1�CHeRG[ <br /> imeorca+sr nu+sevraovmev CITYOFEVERETT weiceana5 I <br /> LOCALSALES <br /> ���� TAX COOE IS 3105 70T�L <br />