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APPLICATIC� FOR CONSTRUCT�N PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •257•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS /q2� �A/�lfx1� <br /> '/ � /1� /('�ZD� E�r,-. <br /> owr��fl✓� `0� uuinooacs�%7� CDn�I�I/� /�!� nv C/��� �wxE �O/ <br /> iENA� MAILAp011E55 LILY 2N PMONE <br /> ARCIIRECtOPpESqNEP 1A�IL�ODAE55 C�iY 2i PHONE <br /> G[NEMLCONiiiACTOf1 MAiU��PE55 GliY ZIP PIqN[ FIAIELICENSE� <br /> Cro� .�a�/.e•��F -�rd 83� �/uJ Sls's� ��/ 9,�� G���a l'c959/'-s,���z,fil, <br /> I.�ECI�tCOi1iF�CiOP A1qlA00FE55 CIiY ZV PIIDNE A�tELICENSE� <br /> ! '1 1� <br /> �PLUI.IOi1�C ONT(1PCL0�1 I.PILAOOPE55 LILY 2iP P1q11E SiAIELILE115E� <br /> ��,�.� �, <br /> cameac*vi cea�wone <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> CESLflI,OEWORNAN�50U�f1F�FC0iGEI1N VE� l GONtACiPCfl50NANOP11011E1q <br /> /'(/�f%JAC.{_ �Ol �J . �! �/."i� <br /> K9�i . <br /> I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> rnorosso use ov euaqwc �// pqOVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TIAE OF <br /> J% /R "�Q����/ /��� ����n� WORK WILL BE COMPLIED WITH WHETH�R SPECIFIED HEREIN OR <br /> �¢cuoEsycnianor/ cvao�eerv��sn�a'w/r�ee�ow PAii�CNiVlOLOPIES) NOt TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �o* <br /> q.S.�(Q B�p���OF AUTHORITV TO VIOLATE OR CANCEI THE PflOVI510N OF ANY <br /> OTHEfl STATE OR LOCAI LAW REGULATING CONSTRUCTION OR TfiE <br /> PERFORMANCE OF COMSTflUCTION.7HAT I AM AUTHOPIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFOflM THE lYOiiK FOR WHICH <br /> APP ICATI N IS MADE AND I COMPLY WITH THE STATE <br /> annce�uxio.rmue[e C TR i R y2�7,/�jCWAND296200WAC. <br /> Z�gl �2eo% � ��.r/ � <br /> cor,iwe*ioriiaernervoen.nooness.re¢rnor�Ermuaen ,/.%l �G /� /���� <br /> SIG PE OAiE <br /> QtY pU51NE55 ULENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OA ITEM FEE NO. TYPE OF EOUIPRIENT FEE <br /> WATER CLOSET(TOILET� A�C—P/HNOLG UNITS <br /> BATHTUB FORCED AIR SVSTEMS <br /> LAVATOFY�WASH BASIN� HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> NITCHEN SINK 8 OISP CLOTHES OflYERS <br /> DISHWASHER RANGE HOO� <br /> LAUNORYTRAV ! WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(W000 BURNING) <br /> DFINKING FOUNTAIN FIREPLACL INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACNFLOW PREVENTERS GASRANGE <br /> SINK�SERVICE—BAR,ETCJ 1 GASPIPING <br /> EXHAUSTFAN <br /> SUBTOTAL S SUBTOiAL 5 <br /> PERMIT 5 � PEflht1T S <br /> TOTALFEE 5 2 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> ��O'IiSCi�nCK PEARSEi9ACN Si0E5EtBeLN PWICNELRMIIABCR FEE �[CEiPiNO <br /> wczor.e torenee vncn.visrte FEES VALUATION FEE <br /> ❑v¢s ❑xo em�onw <br /> ium��rumrturor� rmarownuHn saeora�x✓ri. <br /> mars vwwmirvc <br /> occvvnr¢r uoasionies or:wver�.io.o oeseusrrt u¢e�un�eu <br /> cccuo <br /> ❑YES O NO <br /> �.'i.SPRINRLERPEO➢ PEASON ROOIi1pNA�pUNCNLCK <br /> OillEfl <br /> 1111EFLAPMflEOD RGSON <br /> SiEiE BNtORlG SURCIIARGE <br /> 1vPE0FCON5i PUNSAPPPOVEOBY CITYOFEVERETT W9LCWORNS <br /> LOCALSALES <br /> oarE TAX CODE IS 3105 TOTAL <br />