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APPLICATION FOR CONSTRUCTAN PERMI41T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET F EVERETT, WA,9,88201 A,(425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION `I [I BUILDING _emu MECHANICAL ❑ PLUMBING D SIGN <br />7 PROJECT ADDRESS: 7-Ji 14 i71T AN( E: f' �"t-(29001- <br />IT. <br />IEEpA1FCT ORN9d4P uNn ADDRESS - 1I11 lIr rU0,F <br />GEMFI4L CONIRAGIM VNI, ADMESS CITY Ar MqK STATE LICENSEE <br />(9,%'A 79. t f -Z Ec <br />Cd11PACT PEACE OF NORX <br />-% <br />�/ <br />HEATING SYSTEM: KJ GAS ❑ELECTRIC ❑ <br />OEECRBE HOIIK AND SOUAPE FOOTAGE NWLVED <br />CCMACT FFRBON AND PNONE ND <br />t 4n\ 1 �nIA� <br />Q:z <br />LZpm o <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 THIS TYPE OF <br />WORK WILL 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 IT HE <br />OWNER OF THIS PROPERTf TO FORM THE WORK FOR WHICH <br />APPLICATION IS IAiI� ( 1 COMPLY WITH THE STATE <br />CONTRACTORS 18. AN 296200WAC. <br />X_. <br />OEgTONDUSE aF eulLdNa <br />LEGAL DESCRIPTION W PEgPERTY ISKML BELGN CA A"ACH NA CMESI <br />L07 DLBCK N <br />PARCEL TAXI D. NUNBEP <br />CdIS1flJCTIdIIOAN tENDEfl. Apd1f35. [RMINEMMBER <br />SIGNATURE ATE <br />CITY BUSINESS LCENSC NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPEOF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET, <br />A/C—A/HNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER IIEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />J_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR BRAIN <br />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />SIN SFIBACK I MANCIIECrj5AIAAIE9 _ I FEF <br />USE ZONE IOF NPFA VACANT SITE <br />DYES D ND BUILDWS <br />E4IGHT IINITAIIGN INO OF OWELUNG ISIEE <br />UNITS <br />MU4BIN0 <br />ASEMENT <br />DYES D NR <br />NECHANCAE <br />ABdT1(N1A1.1YAY GIEGK <br />OTHER <br />STATE BUILDING!TTWIDIWi <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />nlMr.rmPAB <br />-- <br />TOTAL <br />