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APPLICATI� FOR CONSTRUCT�N PERMIT <br /> CIN OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •(425)257•8870 <br /> ❑ DEMOLITION p COMBINATION ❑ BUILDING ❑ MECHANICA ❑ PLUMBIN6 ❑ SION <br /> PROJECT ADDRESS: �� �7 G�QI�-S ��� G,v/ �r� GG�f , �'�� <br /> ���/�2 If�O�EN /.�0� (/la/(S kI'C-'YC/7 LAJ({ ��'/I 'j.?S.�L� Ol��iS� <br /> owvFn �'�^ /� vul�Od�F55 an iir � �MN[ <br /> .N)'/77(.� _ � <br /> 1[N�N��/ N u�ll�fIM65 GIIY !�P PIqNF <br /> /✓//' <br /> •M;ItlRL1�011UE5�GNC11 M��I�U��E55 C�IY !R AqNf <br /> GfN[ IGO��IML1IX1 M�M1�Db�C55 O�V li0 P�q4( S���LI�CENSF• <br /> �,�N�uf Ds�ys /�'�01��1 �z� //GZY >�`P�Sr�`S�i��J w�r 03/l3� <br /> uKruNiPl f.0. neclon � 4�M1���55� C�iv l�r V`�bM1t 5� f l C[ C <br /> �� '."'_� JyJ�'�.�A/,v`lDl? 04f,rA <br /> IIIIMPII�GCOIIIP1f,1CY1 N�III�CIMC55 fIIT �. �'11'JNF ^)S1A�FlKfMSf• <br /> ����/ � <br /> covm�c�nucc or wan� HEATINii SYSTEM: ❑GAS O ELECTRIC ❑ <br /> J! 2 S N� <br /> �rscm FwonK�vusou��r�oo«ce�u�roi�co can�c�rrnsw��Horirovrr�o <br /> / 9IG � ��.�L 'e �C!/[ <br /> L J�Y L 1'/,!� �L 7 <br /> ���� f F I HEREBY CERTIFY TNAT I HAVF READ AND EX�MINED TMIS <br /> pPPUCATION AND NNOW THE SAME TO OE TRUE AND CORRECT ALl <br /> n�roro ousc oF nunaun PROVISIONS OF LAWS AND OROINANCES GOVERNING 7M15 TYPE OF <br /> WORK WILL BE COMPLIED WITH WNETHEF SPECIFIEU HEREIN OR <br /> irc�iorscmnnwo�rnor[nrv�swwrvnaowon�nrtrnwocon�s NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> ia oia� or AU7HORI7Y TO VIOLATE OR CANCEL iHE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTPUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TNAT I AM AUTHONIZED BY TME <br /> OWNER OF TMIS PROPERTY TO PERFORM TME WORK FOR WH�CM <br /> APPLICATION IS MADE AND I COMPLV WI7H TNE STATE <br /> PAOCCI IA�10 MMPf11 CONTRACT RS LAW 18�2)/RCW ANO 796300 WAC. <br /> = ""n' ��J� 00� O"°a � �,�ll/w'� ���L/_� <br /> cov��ni�cricw�a�H�[Hnrn�otMEss.�ncrva+cmnmcn x � <br /> y our <br /> L11Y BU4NC5S IKCHS[NO � <br /> PLUMBiNG MECHIINICAL _ <br /> NO. TYPE OF FI%TURE OR REM fEE NO. TYFE OF ECUIPMENT FEE T_ <br /> WATER GLOSET(TOIIET) A/C—M7ND�G UNITS <br /> dATHTU� FOPCED AIR SVSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SMOWER UNIT HEATERS <br /> KITCMEN SINN d OISP CLOTIIES URYERS <br /> D�SHWASIIER RANGE HOOD <br /> LAUNURY TRAY WAiER HEATER i <br /> CLOIHES WASMER WOOD STOVE � <br /> 11RINAL METAL FIREPLACE(VJOOD BURNING) I <br /> DRINKING POUNTAM FIREPLACE INSERT�'JOOD BURNING) I <br /> FLOOR DfiAIN GAS FIREPLAGE <br /> �IACNFL0IYPREVENTERS GASHANGE <br /> SINK(5[RVIGE—�AR.ETC.) GAS PIPING <br /> E%HAUSTFAN <br /> i <br /> SUBiOTAL S SUBTOTAL f I <br /> PEiiMIT 5 PERMIT S <br /> — TOTRIFEE S TOTALFEE S I <br /> FOR OFFICE USE ONLY: <br /> �nputFin•CK nrenSna�CR s�DEsr�BKa rteHO�Ec^uuqxru rrr nffnmeo i <br /> o;vorr la�nt� wtnv�suc — F E� V�LUATION FEE _ . <br /> ❑v[5 ❑r:0 Rulbqf. I <br /> uEIG���I�'���A�IOV ;O'OrUW[llllq 512EMBlW9� i <br /> ry114P�4fi __ ._______��_ <br /> IX:llif�\I:� M1`����`el1 OCCVMN�IU�II B�SF4[NI Mff.1��Ni(�I . _ <br /> C.�10111• <br /> 0�[5 Q N7 <br /> •onnnru n.vartc• <br /> rmisvu:.:utnem'o— nFesrn+ _ —_ <br /> o��rc� <br /> r��<innunw�o - nrwm <br /> sua ninm�vr,s�irc��•�cc <br /> nrr r,i ruvn r�nes�rrnovrnor CITY OF EVERETT rvini¢.ww�.s "' _ _ " <br /> LOCALS�LES — — - — <br /> ���� TAX COOE IS 0105 TOT�L <br />