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APPLICATI� FOR CONSTRUC7�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 99201 •257-8870 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDINfi � MECNANICAL ❑ PLUM8ING ❑ SIGN <br /> PROJECT ADDRESS <br /> 3oV VKar'Nolw G�e �uereh* W,4 9P203 <br /> }OwNEP u�K�WnE55 Lltt IP i�pryE <br /> �C-Nut3 �� $tRc-�cH 30(a /rlOqnol�a �'.ue. �uPxe�' G�vh �iF10'i C`iZ5)3�F�-'z�10 <br /> TEN.WI 4AR�OCPE55 [IIY jp ���pryE <br /> I.PCMRFCiOPDESqNCN M4ilA�OPE55 CIiY ;p p�qpE — <br /> GENElIµCONiql.�ipq Y�M1�WFE55 CI1Y IW P1q1E ST1iElICENSE� <br /> �MECIONIGlC011iRACiW YqLADCPE55 GiY 2W %qNE Si�tELICENSE• <br /> �w ner <br /> RIIMBINGCONIR�CiOR MAILPC:'nr�r� �IiY TIV � <br /> - ��� sure��xsc• <br /> LON1MCiFRCEOF WOPK — <br /> HEATING SYSTEIII: ❑GAS ❑ELECTRIC ❑___ <br /> �UESCF�BEWOP81Np 4PEi;10iPGFlp�IXVF� �OIIiLCiPEP5p1.WOPIq4Elq. <br /> 35 1"D �.lse IYuvH� S �recl" __ __ <br /> I HEflEBV CERTIFY iMAT 1 HAVE riEAD AND EXAMINED THIS <br /> enoaos[uus[orem�oi�: APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> i.�r,� -- PROVISIONS OF LAWS AND OROINANCeS GOVERNING THIS NPE OF <br /> WORK WILL BE COMFLIED WITH WHETHER SPECIFIEIJ Y.EREIN OR <br /> iew�oeuniatbHa�raoarnrr�sirowmeaownaerrecxrnoca�es� NOL 7HE 3RANTING OF A PERMR DOES NOT PqESUME TO GIVE <br /> !o* azocK___or___ 4llTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANV <br /> OThSR STATE OR LOCAL LAW REGULATING CONSTRl1CTION OR THE <br /> ._ PERF�RMIINCE OF CONSTRUCTION.THAT I AM AUTqORIZEO BV THE <br /> OWNE9 OF THIS PROPEP,TY TO PERFORM THE WORK FOR WHICH <br /> APPLIG4TION IS AIADE A�10 I COMPLV WITM THE STATE <br /> rnacet ux i o rvuwoEn W NTRA^TORS LAW 182]RCW AND 296.Y00 WqC. <br /> C@ISTPUCTpNLO.WLENOCG,ADDRE55.SElEfNYY,,.'EMI40ER �, ' � / �� � � 'al�O'Q <br /> SqHAiimr a.�— o�rt <br /> LIiY BUSME55 ULENSE NJ <br /> PLIIMBING MECHANICAL � <br /> NO. TVPE OF PI%TUNE Ofl ITEM FEE NO. T`fPE OF EOUIPYENT FEE <br /> WATER CLOSET(lOILET) NC—AMNbLG UNIT$ <br /> BATMTUB FORCED AIFI SYSTEMS <br /> LAVATORY(WASH BASIN� MEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK fl DISP � CLOTHES CRYERS � <br /> i <br /> DISHWASMER RANCE HJJD <br /> LPUIJDRV THAY WATER HEATER <br /> CLOTHES WASHER WOOD STUVE <br /> URINAL METAL PIRcPLACE(WOOD BURIJING) <br /> DRINKINGFOUNTAIN ' FIREPUCC-INSERT�WOODBURNING� <br /> FLOOP DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENiERS GAS RAN(iE �— <br /> SINK�SERVICE—BAR,ETC.) GAS PIPING <br /> EXHAUSTFAN � <br /> i <br /> SU9TOTAL 5 SUBTOTAL S � <br /> PERMIT S PERMIT 5 <br /> TOTAL FEE 5 _ TOTAL FEE 5 � _ <br /> FOR OfFICE USE ONLY: <br /> LPONi561BALM p[ApSFBALK Si0E5ELB�CN PUNCtlECMM1MQEF GEE RECEIPTW. <br /> useznre �otna[e v�uut5rte FEES VALUATION FEE <br /> m[s �ra ewioixa <br /> neia+ruuiurroH xoa�mvcunia s¢rcre�oan <br /> ururs <br /> cwuamc <br /> oc�iman-r masrx�s rxcuv�nrio.o e+scucr:r <br /> LFOVV � YECIIANIf,4 <br /> OYE5 ❑NO <br /> FlFESPR:NRLEliPE00 FE�SON �WD�INNULPW1C11E'.R <br /> oincn <br /> in�euraur�soe ne+wx <br /> SiAiE BOILpl1q iVPCNMGE <br /> rvnccFmr�;i r�urs�rvaweonr CITYOFEVEHEI'T weiawouas � <br /> LOCALSALES <br /> oae TAX CODE I5 7105 TOTnL <br />