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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET EVEREtt, WA 08201 ! 258-8810 <br />I I DEMOLITION I I COMBINATION I I BUILDING MECHANICAL I I PLUMBING I I SIGN <br />PROJECT ADDRESS _ ) n r1 n , . n __ <br />IFIIANT MAIL At"F SS CITY <br />__- <br />MC.IKIFCI On OF51@Irn <br />MAK AOORFS$ <br />_. <br />CITY <br />T---"-_-- r <br />rIIONF <br />7iP <br />rnnNF <br />51AIF.IICF45Ft <br />RFNCnAL f,ONInAf.lIXl <br />MAILAMXIFSS <br />r.I1Y <br />MFCNANICM CONIniCION <br />MAIL ADDnFsS <br />CItY <br />]m <br />r110NE <br />STATE LICF.NSF r <br />PIUMBING CONTFUrTOFI <br />MAIL AUDnESS <br />CITY <br />71P <br />PHONE <br />STATE LICFNSFr <br />PFII E or VYO]IK <br />% [ N1 1-I HEATING SYSTEM: GAS IIELECTRIC fI <br />..�— <br />hFSCIKBE MOfIK Af/Il SOl1AfIE FOOTAGE INVOLVED <br />f.OrlIACT rrD j1! AHn r11ONF Nn <br />— <br />StJSTALL GP5 �'l)I`RNAC.F <br />— -- 1 ��- ��15_----- ------ <br />1SiRLL GAS 1nW <br />--��— <br />— <br />I HEPE3Y CERTIFY THAT IHAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE or <br />momsco USE or mukut o <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN On <br />NOT. Tilt GRANTING OF A PFAMII DOES Not PRESUME TO GIVE <br />iFOALBESCrertroNOFrnDrentv(SNOMfiEtOWORATTACH TWO Ct"ES) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />tot—eLOF:It or— <br />OTHER STATE OR LOCAL LAW hEdULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY f0 PthropM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA ` ORS LAW 18.27 RC AND 288.200 WAG. <br />x � � d�( �-- � �-17 <br />PAnC.FL TAXI D. moABEn <br />�f3 1_��9- oas- ��; <br />CONSTMICTK44 LOAN LENUER, ADOnESS, TELEFI OW NUABE1 <br />SIONATUnE DATE <br />CITY BUSINESS LWENSC NO, <br />PLUMBING <br />MECHANICAL _ <br />FEE <br />NO. _TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET(TOILET) <br />A/C—A/HNDLOUNIT3—H.R <br />r.— <br />_ <br />BATHTUB <br />' <br />�— <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />__ <br />LAVATORY (WASH BASIN) <br />r <br />HEAT PUMP <br />! <br />_ <br />SHOWER <br />_� <br />UNIT HEATERS—B.T.U. M <br />' <br />KITCHEN SINK 14 DISP <br />i <br />CLOTHES DnYERS <br />---_--_-_-- <br />_ <br />DISHWASHER <br />--- <br />-VENTILATION FAN <br />_—.—i.—__ <br />_ <br />LAUNDRY.i RAY <br />I <br />RANGE HOOD <br />_ <br />WASHER <br />�— <br />WATER HEATER <br />_CLOTHES <br />URINAL <br />'_ <br />WOOD STOVE_ <br />—} <br />DRINKING FOUNTAIN <br />i <br />�— <br />_ <br />_ <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />.y — <br />FLOOR DRAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />__ <br />(SERVICE — BAR. ETC.) <br />— <br />_ <br />_ <br />GAS RANGE <br />_ <br />_SINK <br />GAS TIMING <br />EXHAUST FAN <br />' <br />---- <br />-- <br />I <br />SUBTOTAL S <br />' <br />SUB TOTAL 1 <br />' <br />PERMIT S <br />i <br />PERMIT 1 <br />!— <br />-TOTAL FEE 1 <br />TOTAL FEE S <br />FOR IFFICE'JSE ONLY: <br />roo"I SFIFACN <br />n An SFIRACK <br />Sint; SFIMCK <br />PIANcTIrrK NIIAIBrn <br />nrcrim no <br />_-�frF <br />- FEE$ _ VALUATION <br />----- ----'--- <br />—'-- -- <br />Usr 71KIF <br />IOt nnFA VArAr1I SIIF <br />11YES 11 NO <br />-- <br />IX (IIING S17F Or fit DO/II <br />nIn1DINn <br />""-"-"--'"--- ---'-- - -- - - -- -- <br />--- - _ -_ -- - <br />------ ---- <br />11FI1Im LIMITATION <br />1INO <br />NItS <br />ft I)MAINn <br />Mr C.11AIIICAI <br />p1:C11PANCY <br />Nn Ih SIMFFS <br />OCCHPANT LUAU <br />FIAGFIPFNI <br />nnmr <br />AnNIIIONAI PI AN C.IITCK <br />--- --- <br />r IRF.AURM nFOn <br />nF ASCM <br />OIIIrn <br />FIIIFSPMNKIFnnFOn <br />n A 1111 <br />---"-- <br />�I nNs nrrnnvn'Bv CITY OF EVERETT <br />STATE noKnwn SNnrllAnnE <br />PNnrtr.wnnKs —'----'— <br />- -'-- '- <br />----..__ r - <br />IVPFIKCrNlSI <br />SALESLOCAL <br />TAX CODE S310S <br />TOTAL <br />