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APPLICATIN FOR CONSTRUCAON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: Ln631 �r t-M4,. I .,P <br />L", A- n N. `1631 F-yerc 3412 L ass(- <br />OwN[n 44t APwFSS dtt tm PNON[ <br />ANCIYRG1 w M0 N[n MAN ACOOSSS <br />WN1n4 CONInni 1 Vol ACM1F52 Gh k. PNryd 541[IiC[NSf, <br />WCNAMC4 CMI..ClOn MAIL At' SS Orl pP INA:r "OF tcENSE. <br />FNUWNGCONIRACTM MAk AMMESS OlY IN' PN91{ SIAIF IKEN4. <br />Coxln.c, PMCE OF wad <br />HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br />MSCWPF w'JRM AMa Sd1API iO0,1GE NVp VEP <br />00 S un AS <br />/' <br />-Far <br />CCNI.Ct M." AM) hgNF NG <br />0,La <br />l^ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THUS TYPE OF <br />WORn WII L 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 />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I 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 />CONTRACTORS <br />�� LAW 1027 RCW AND 296200 WAC <br />!iv (ti <br />✓A41� 1„1 /S <br />r•IIO,•Osfouu a pnxdM: <br />LEm[oE5cmn11dAa PlgKntt 6NGwN anaw on.n ACn lwo co%E 51 <br />LOI aLxa M <br />PARCEL,.IO MAAPER <br />fANSiKKIKN IO.N I FNMR. AdWC55. FELIMONF A NPFN <br />CITY P114MSS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —AAINDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOT14ES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL S <br />SU8 TOTAL f <br />PERMIT $ <br />PERMIT f <br />_ <br />TOTALFEE S1 <br />6 <br />1 <br />1 TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />III I "CF., NO <br />ME AIX1F 110, <br />OYES O No <br />awr.Nr. <br />INIONt 11N1A1104 <br />NO MIM'IIIIMG <br />SIiFMNOGNI <br />.� <br />IIN115 <br />%IIYfl�NG <br />NCY Y)%SIIYIf <br />CCCIM.NI LOAF <br />a.MNEN1 <br />4{I:MAM[A1 <br />DIES 13 M <br />.Dd M1NM n.Nclra <br />fFF SRiMNIEN KQD <br />MA." <br />011ie <br />{IKAIAPMKOD <br />MA" <br />- <br />SIAIF WNW. W. 510FKIA.K.E <br />trKal:alNi <br />MANS VA 0FIT <br />CITY OF EVERETT <br />nmllcwm.E <br />- <br />LOCAL SALES <br />--- — <br />- <br />1 TOTAL <br />�.Ai <br />TAX CODE IS 3105 <br />