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APPLICATIG.� FOR CONSTRUC7 .JN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •259-8810 <br /> ❑ pEMpUT10N p COAA8INATION .�BUILDING ❑ YECNAlIICAL ❑ PLUMBINC ❑ SIGN <br /> PROJECT ADDRESS: <br /> wE5 � a�vs� ��� �� � . ���� <br /> pvr�n wui�oa�u nn ziv na� <br /> �a� � <br /> rewwr ►wi�oacss un aa v� <br /> �L'T� �i�r�4�'�r dlL� '`'Zd S' /{�i1j�/,� £cl • 9Sr�3 <br /> uia',rt�c�on oe�n wut ss ' an zm o�r+e <br /> t�sN� D �.�a�rrD��uc �l&a�F„��.� � � 9kzo� as9-a�zz Q-Go��2vy-Sai- <br /> (��{WCpNTMGTOR M IMdIE55 LIIY IIf` P�qNE CfATEIICENSE• <br /> TpR MNL�Od1E55 dTY I�P VNONE ST11TE IiCENSE• <br /> q TR�CTOII 4�IL�OO��E55 Gn' Z�P �'MONE STATE LICENSE� <br /> S� �� <br /> caaw�crvr�oFwonK HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> OE^�1MOI�f GM1D SOUIJIE F00T110E RIVOLVED CONT�CT PERSON M1D VNONE NO <br /> LE �� "' _ <br /> 1 HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMIHED THIS <br /> APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> vnoroseotrse oF euxnMo PROVISIONS OF UWS AND ORDINIINCES GOVERNING THIS TYPE OF <br /> ylpqK Wl�l 9E CAMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �c�pEy,wr�qNapiqpEpiv(s+qwMeuowOn�rr�wtwocoAEsl NOT. THE ORANYIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATE OR LOCILL U1W REGUUTN6 CONSTRUCTION OR TME <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNOfiIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFOFiM TME WORK FOR WMICM <br /> APPLICATION IS MADE AND I C lA LY WITH TME STATE <br /> (�MT AW iB27 RCW AND 29 2 WAC. <br /> ..�. �q.�_�3 ,� Z& ^Q�S 2-Z� -9lo <br /> COMSIRUC110N ldW lENOEN.110011E55.lELERqpE M111lEN x <br /> ��T� D�TE <br /> GTYlU9NESS 110EN5[NO <br /> ��d IAfq1ANICAI <br /> N0. TYPE OF Fl%TUIIE OR ITEM FEE NO. 7YPE Of EOINP�AENT FEE <br /> WATERCLOSET(TOILET) ' MC—AMNOLOUNfTS ' <br /> �TM� ; FORCED AIR SYSTEMS �_ <br /> UVATORV(WASH BASIN) � HEAT PUMP ' <br /> SHOWER � UNIT HEATERS ' <br /> KITCHEN SINI(8 DISP � CLOTHES DRYERS � <br /> DISHWASHEA � RANGEF100D • <br /> UUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> �R� � METAL FIREPIACE(WOOD BURNING) ' <br /> DRINKMKi FIXIHTAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> FLOOR DRAIN � GAS FIREPIACE ' <br /> BACKPLOW PREVENTERS ; GAS RANGE � <br /> SINK(SERVICE—BAR,ETC.) GAS PIPIN6 ' <br /> � IXHAUST FAN <br /> � ' <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL f ; <br /> PERMIT t � PERMIT f � <br /> TOTALFEE f � TOTALFEE t ' <br /> FOR o�ce use uN�r: <br /> iR01�i5ETSApf 11EMSETMICR SIDESETe�C�( �lANQ1ECICNUMBFR fEF RFf.E1PTN0 <br /> usE za� �or�n¢� VAC�Nt 51TE FEES VAIUATON FEE <br /> ❑r¢s ❑no euiomc 7� ; _ <br /> ��r uMurwM ra or vweuna s�a e�oarti � <br /> unrts vwunnic � <br /> occvr�ncr ia a s�rncs occ�T iow e�ueNr MECN•wic�� <br /> 6�R OYES ❑MO � <br /> FIAESRiMKLERflEO'D RE�W�'� �ODi710N�liR�NCNCLK � <br /> --�-- <br /> OINER <br /> FIRE NAflM REO'U qEACd1 — i ��� <br /> S7AlE BUIlU1NC SIIRCNMiGE 'YSC <br /> TrvE a r,oasr ou �vruov¢o er CITY OF EVEREIT ruai ir,wor�Ks <br /> ��N�• �Ih. LOCAISALES �,5� <br /> �P��� DATE -�0-� TAX CODE IS 3105 TOTAL _�_�� <br />