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APPLICATII FOR CONSTRUAON PERMIT <br />CITY OF EVERETT e BUILDING DIVISION <br />3200 CEDAR STREET a EVERETT. WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 1k MECHANICAL ❑ PLUMBING ❑ SON <br />PROJECT ADDRESS: CIS Nq rl,-Go IA/ _ <br />h (-/- C.l 1 * Zon AJA n <br />6ENfPM •..-..w...•..- - <br />/ 04,L7ll+lr.c)itn � / �O �A P. � uAAz gxw /yxcE *'kd� I Ci 6 <br />W ,...CAICpiln4.lUa 4AM Atp 55 Clrr IA' P�KHf LII IKLXS—E LA <br />NuA* GCm,".1 m 4N ADCAIS5 Cni IX rlpVF SIATIF II Pl%F• <br />� 9�'aOv of <br />pQN1�"Aj0T r"rtf "r wnnll <br />HEATIIIG SYSTEM: O GAS ❑ ELECTRIC ❑ <br />LfSCM1eF WJn11 AVo 5WAaF rC1�IAU MVpHo <br />r-TACI rr nSUYAM rPaa V(1 <br />I <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 />r omolmt IN m".. <br />_ <br />WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />IeGAL NSCmPTl araorLP" ISIIO I KLIow oP AnACII 11s'O Cm"I <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />Io1 HOCK a <br />DINER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIOA N1 15 MADE AND I COMPLY WITH THE STATE <br />C04T CIO IAW 19 27 RCW AND 2%200 WAG <br />vAPctL IN 1 o ruL1eF <br />/ZZ8-642 <br />CGwirllcrl IOAH HNIfRA fss IrUH10XiM 'I <br />X <br />S•CNA'. PAH <br />Cll♦m14551A1 wit VO <br />------ <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EGUI %NW <br />FEE <br />WATER CLOSET (TOILET) <br />NC —A DLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES ORT'ERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER NEATEN <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPIACE (WOOD BURNING, <br />URINAL <br />FIREPLACE I4SERT AVOOD BURNING) <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />GAS FIREPLACE <br />_ <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE — BAR. ETC I <br />GAS PIPING <br />-- <br />EXHAUST FAN <br />SUB TOTAL f <br />PERMIT f <br />1 <br />_ ___ PERMIT f <br />TOTAL FEE S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />I IXMT vrn Arx PFM SrrKACK <br />uv /UVr <br />IolAm. <br />. i <br />--_ <br />O YIs G MI <br />KI'.IIM•Mi <br />NIGn111NIAIILW <br />mIV OWLIllw6 <br />5.11 O• Nw.11 <br />1'I.lw1 l <br />WI:PAPYAI <br />OCC...... 4pry 111.11 <br />MCVrAHI LOAD <br />bL5rN n1 <br />f.P011r <br />OxfS O•Af <br />— <br />AOp11oYA1 M1xM CNCs <br />r IPL SrIbIFI[X pLYO <br />rr Ai(M <br />OXrtX <br />_ <br />rlPf AU11'1 P100 <br />11f ASOV <br /><IAII K1xIDM1i 51MC11AI1G[ <br />nrctw rovct <br />M1APSA Wwrner <br />CRY OF EVERETT <br />n IAc <br />,,,,,-{\..Q� <br />LOCAL SALE$ <br />TAX CODE IS 7105 <br />7OTAL <br />__ <br />