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APPLICATIOR FOR CONSTRUCT�N PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDA9 STREET•EVERETT,WA 98201 •(425)257-BB10 <br /> ❑ DEMOLITION ❑ COMBINA710N ❑ BUILD�NG �MECHANICAL ❑ PLUMBINO ❑ SION <br /> PROJECTADDRESS: G�"/ GLENi.J�uL� �IV� <br /> Gfa�✓/ 621'inL� (obol �iLENt�.ocP fV� �i/� yBi o3' ��fZS�35$-3G�J5 <br /> ow�vr — u�ii�om�ss Cn rm rrrorc' <br /> IfN/.YI 4UI�I%M�ftS fIIY )Ip NqNF <br /> �11C�ailClO�f1E5iG�'fP M��I���WSS Pb 81' PMONF <br /> GtNIMICOH�MClry1 v41��[N�F55 Plv h� �h�OK c41tlICtMSEr - <br /> (�i(Vi1i t:/` <br /> MfP��NIC0.004M�C10� R��l�C1ME55 p}Y )ip PIIJNf 54tFl�CENSE� <br /> [JIMBIVGCOMMf.I(%1 4111�WBE55 CItY JIP PMO4F Sl�ffLICfYSF• <br /> Z337. :0 <br /> ca+m���mact ar nvnx <br /> i���N.-� F.`i GAS :r•r� � v�� P�PL�/�J q{o4LU HEATING SYSTEM: AS ❑EIECTRIC ❑ <br /> D[SCIFPF NOUF/.Mf)SW��E�Mf�GC mVOIVfD CWi��I ry�aS�N�NO n��qn'p <br /> �5i�yv� I HEREBY CERTIFV THAT I HAVE READ �ND �%AMINEO TMIS <br /> rrioroseouss,.�nmm�a . APFLiCATION AND KNOW THE SAME TO BE TRUE�ND CORRELT�LL <br /> 7 � PPOVISIONS OF�AWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORN WILL BE COMPUED WITN WNETHER SPECIFI[D HEHEIN OR <br /> ireuoescnirnar�wrnor[nrv�s�awxartowon�ni.cx�r,oca+[s� NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �0� moc. or AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY <br /> OTHER STATE OR LOCAL UW REGUUTING WNSTRUCTION OR THE <br /> PERFORMRNCE OF CONSTRUGTION.THAT I�M AUTHORIZED NY THE <br /> OWNER OF TMIS PROPERTY TO PERFORM THE WORN FOR WHICN <br /> APPLICATION IS MADE �ND I COMPIY WITH TNE STATE <br /> .n,�p��i��y i o mluBtn CONTRACTORS LAW IB 27 RCW ANO 496 200 WAC. <br /> covxmu:r�wiwN��rmrn.Nxurtss.rti[n�exuuncn X�L�_� ��il��. Z-Zs-9g <br /> saenun[ d wrz <br /> C�lYBU9M55lCLN5C NO <br /> PLlIM81NG IAECNI1NICl1l <br /> NO. TYPE OF Fl%TUHF.Oq ITEI• FEE NO. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSBi�TOILEn q/p—A'HNDLG UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WAFM BASIN) NEAT PUMP <br /> SMOWEP UNIT H[ATEAS <br /> KITCNEN SIN✓,A OISP CLOTHES ORVERS <br /> DISMWAS��.FN PANGE HOOD <br /> LAUNDRY 7RAV WATER HEATER <br /> CLOTHES WASMER WOOD STOVE <br /> URINAL METAL FlREPLACE QNOOD BI�RNING� <br /> DRMKWGFOUNTPM FIREPLACFI45ERT(WOpDBURNING) I <br /> FL0011 ORAIN � GI 5 FIREPLACE Z ��] 'zJ <br /> OACNFIOW PREVENTER$ GAS RANGG ' <br /> SINN�S�RVICE—OAR.ETC.) � GASPIPINC+ <br /> E%HAU� AN <br /> T— <br /> SUA TOTAL 5 SUB TOTAL E ' 'Y'J�Z—?J <br /> _I PERMIT S � PERMIT f —�— <br /> TOTAL FEE S i� TOTAI.FEE S <br /> FOR OFFICE USE ONLY: <br /> �naurvrrn+n nr�nsnn.cK snKsne�cx ruxai¢.r�uxrn � r¢r ���mm��o <br /> u'�novr �oieace wuma�¢ FE 5 V1ILURTION FEE <br /> ❑r[5 ❑wu �— <br /> R��ipN(: <br /> 11EIONII�41�I��ION HOCfOW(IIIMO SIIEdB�DG�I� <br /> IINII� ry114RIVC <br /> ��� <br /> CCCVPw4<v M10i5VnK IX:COM.NILO�D PFSfMEN� ptf'14MCt1 <br /> c�our <br /> ❑Y(5 O NO — --— "- <br /> (iRESPHINMLCPPFOD M/.[p6 �CpVp4qP1�NPIfCr <br /> 011�(I1 <br /> N�[�UIOlptU'D IIF�TOV '- <br /> $IEII P�IRUING 5�111C�4fI4F <br /> �rrrntrova v�..Ns�rmovvnnr CRYOFEVERETT rnnur,wrn�+c <br /> IOCALSALES --- -- ------ <br /> _ „•�E TAC CODE IS J1J5 TOT�I_ �_ <br />