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APPLICATION FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISICNom;ff <br />3200 CEDAR STREET • EVERETT,'NA 58201 E (425) 257-8810 J <br />El DEMOLITION ElCOMBINATION❑ BUILDING ❑ MECHANICAL RLUMBING ❑ SIGN <br />PROJECT ADDRESS: ! -I Q Z S• E- e'EJ / l /y1,11 !L <br />OWNEn MAIL AOdlE55 Ott SIP PNONE <br />G Te l�/�+� .��rA�7- <br />IENANI 4M AMIIE55 On SIP PI x <br />MECNANIGL CONTRACTOR MMLAMMESS GLV TIP MgNF 111I 11ICENSE• <br />P.o,a!n 333T 98s�4 0-��3^�I- TiA3rs+1)3YA� <br />PIIMRMGCOIIIRACTOU MAILADDINESS CITY F TIP PNOHF SIAIF IKENSF• <br />cONTMci PnICE Of KURx `/ <br />"7oZDp l <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />OEWROF WORK ANDSOUARf FOOTAGE MVOLVEO <br />c .CT PERSON Aml I`~ NO <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL 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 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.yCW AND 296.200WAG <br />�f//A. <br />— <br />roaroSFd vsE tx BDndNa <br />LEOALPEKINPTION Or PI A" ISHOINN RELONOn AMACN TWO COME51 <br />LOT IAXK Or <br />IWILnwI➢mMD[n <br />COSTAXTIONLOANIENINFRAIXMITLENIONENUMBEn <br />— <br />SIGNAIURE 'WE <br />CIF" HUSNESS LICENIE 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—AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />.:L <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK d DISP <br />_ <br />CLOTHES 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 />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />I R[INT V7MIC <br />AFAR SE18ACx <br />SIDE StHUI <br />MAN CHECK NU <br />FEF <br />NFLFIPT NO <br />v <br />USE SONF <br />IDS ARFA <br />vA ANI VIE <br />FEES <br />VALUATION <br />FEE <br />—�— <br />- <br />O"Es ONO <br />dAIdNG <br />MIGNI IIMIlAl1pN <br />NO CF DWE[IING <br />SIZE M B[DGRI <br />llNll$ <br />PIUMRWG <br />LOCIp pANC" <br />rp fN 51(K{S <br />CCLDPANI IOAO <br />BAVLIfNI <br />NFI;NANN:AI <br />OVFS O NO <br />- <br />iZONlO1M. MANCl1ICx <br />'— <br />IIRES.SNM1AREO'O <br />AfASON <br />OAI[A <br />RREAIMMAfOD <br />AFASON <br />SIAI[ 0111MA'0 VIACN VN:E <br />— <br />— — <br />TYPE Off"I <br />MANS APPRDYfO BN <br />CRY OF EVERETT <br />nIRI N:vARxS <br />LOCAL SALES <br />TOTAL <br />— <br />TAX CODE IS J105 <br />DAI[ <br />