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APPLICATIO�FOR CONSTRUCTI�1 PERMIT� <br /> CITY OF EVERETT•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98207•257•8810 <br /> IB DEMOLITION ❑ COMBINATION O BUILDINO ❑ MECNANICAL ❑ PLUMBINQ ❑ SION <br /> PROJECT AODRESS <br /> OW11EH Y1L�pLY1k55 �,Yfv jp qp�E <br /> ',� oP Ew�r7r 29.b w�M+r�e , �i:nrtl; Wi1 `if�01 475-25j-g�J`J <br /> iENNIt uuL�pppE55 GTY i0 qq� <br /> MCNIiECidlCE5i0MER WL�OpIE55 CIT' l/ R�p1E <br /> GEtiEPALCpIf11ACttJq N/yAppqE55 CRY iP qqH( Si�t(IICENSE• <br /> Asa� �,✓;vaw�vk/.`�D P•o.Bor 3is� MHk,vfm W► 9rz�S yzS-.i`�l•ulrYqpqF.vf�dd�u� <br /> �couwku tartwcroa u�n�oon[ss ntr zv p� si��i��� <br /> �'LUMBMGCd1iMCTON M�L�WRESS �IiY ZP qp� Si�t[IICENSE� <br /> GOViR�LI PRICE Oi Nd1R <br /> �1 HEATING SYSTEM: ❑(iq$ ❑ELECTRIC ❑ <br /> MSCNME�WnR Nq Sq1.wE i0pTA0E�Nv0.vE0 �ry{,ti{yEqspryµp p�qry��p <br /> mJ <br /> 3�3a �'ry[" ST I HEREBV CERTIFY THAT 1 HAVE READ ANO EXAMINED TMIS <br /> rnovououseor aua APPUC�TION AND NNOW 711E SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF UWS AND ORDINANCES GOVERNIN�THIE TVPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED XEREIN OR <br /> lEG4CE5CROTqNOFPMVEqiY�S�qv.NBElOWql�ti�CNM9LO�iE51 NpT.7HE GRANTING OF A PERMR OOES NOT PRESUME TO ONE <br /> io* e�ocK a AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANV <br /> OTHER STATE OR LOCAL lAW EODUTINO CONSTRUCTON OR T/E <br /> PERFORMANCE OF CONSTR qN.THAT I AM KITHORIZEO BY T/E <br /> OWNER OF THIS PROPER PERFORM iHE WORK FOH WHICH <br /> APPLIC ION IS MADE D I COMPLY WITH THE STATE <br /> ru¢n tu i o wue n CONT TORS UW 1B ) AND M6200 WAC. <br /> CpI51RUL1qNl0/J1lEMFR.MplE55.}ElERq11EMIM6FR % �`� O �(�3�I <br /> Sq tUPE pAiE <br /> crtreu5NE55LSCN5Elq <br /> PLUNBINO NECMANILAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE NO. 7YPE OF E�UIPMENT FEE <br /> WATER LLOSET(TOILET) NC—�y�{NDLO UNITS � <br /> BATiNB FORCED AIR SVSTEMS � <br /> UVATORV(WASHBASIN� � NE�TPUMP <br /> SHOWER � UNITHEATERS � <br /> KITCHEN SINN 8 DISP i LLOTHES DRVERS i <br /> DISHWASHER RAN6E MOOD <br /> LAUNDRVTRAV i W�TEqHEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL � METALFIREPUCE(WOODBURNING) i <br /> DRINKING FOUNTAIN i FIREPUCE INSERT(WOOD BURNINO) <br /> FLOOR ORAIN GAS FIREPLACE <br /> BqCNFLOW PpEVENTERS GAS MNGE <br /> SINN(SERVICE—BAR,ETC.) p�5 p�p�ryp �— <br /> E%HAUSTFAN i <br /> i j <br /> i + <br /> i <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERMR f <br /> TOTALFEE f � TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> f1iOHf5Ei0�L1( pFM5Ei01CR SOESEiB�GI( IYANCNECRM111pEq / fEE pEtEWT19. <br /> OVT <br /> u5cza�E toru�[� vw�ntsrte FEES V�lUA710N FEE <br /> ❑YES ❑Iq �� <br /> IIEIGIItI�YIlA1qH IqOipWEWN1 SIIEC�&IX'✓fl. <br /> NnIS <br /> RUYNq <br /> �IIp�NCv q�i51ME5 CCCUP/.NiIOM pA5E4ENt �µ�k <br /> ❑�ES ❑1q <br /> iM1E5PRWMlERPE00 RFASpI /�COIiqM4Rµp1[p( <br /> OTrtR <br /> lFEAW1uPEOD PEASON <br /> $IAtE MILpRq SUR6N11C[ <br /> �.�caconsr vi.xs.wnovEoer CITYOFEVERE7'f wxcwawa <br /> LOCALSALE9 <br /> o�*c TAX COUE IS 7105 TOTAL <br />