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APPLICAT10% FOR CONSTRUCT%N PERMIT <br />CITY OF EVE9ETT R BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 • (425) 257-8810 <br />❑ DEMOLITION COMBINATION fl BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: OT Aim <br />rvr r F <br />,MI. ttGI On OE rG`4R 1.1"IDENnFSS CDE )M 1N 1 <br />JF1+Ylc aS cbovc _ SusrRc* o178G <br />GFNFMI CONIPACIM ..It An(111F55 on, hf Nr^r SIAIF IAEYSFA <br />MFCIIANK4 C041PACIUP YYI ADPF 55 CIM1 Af PNONr %tAIF LICENSE <br />fl(IYpM4rDY111Aftd1 YYI AlArl SS Clry ZIP PNONF STATE IKE 45FA <br />CONTPACT mcEOA `NOP1 <br />IR F q .F <br />HEATING S'f57EM: AS El ELECTRIC ❑ <br />d SCRIPFW RX AND 5 ANr I OQIAGE MVOIVEU <br />CMIIACI MP'd1AM1 f11dR:p <br />MA++ <br />F R <br />I HERESY CERTIFY THAT I HAVE READ AND EXAMINED 71IS <br />APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WE L 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 TINE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF `HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION AW AND I COMPLY WITH THE STATE <br />CONTRACTORS AW 7.]RCW AND 295200 V/AC <br />/ /G-�CI-99 <br />l <br />vlNYnzw ufl or AIPIGING <br />,GAL or gmrPGNd rnoi in" IVIPPM All OW OR ARACN IIVGCORCV <br />lol- _—p1OCA Or F Ct AH.5 <br />A F 5913 06, jO S OO <br />Gp 70 QUO 1 OU�L/ <br />-rl-Rrlr1L <br />IJAv—iO lnlunln <br />C(YI[1RIICl1(»110ANIENdR 4oniss tE1cmR&NNPEII <br />�'. Jy 111tt GAIT <br />Olr PU4r(5514I N[C NO <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT' <br />FEE <br />.3 <br />WATER CLOSET (TOILET) <br />A/C—AATNOLG UNITS <br />_ <br />a <br />BATHTUB <br />I <br />f�ORCEO AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />UNIT HEATERS <br />1 <br />_SHOWER <br />KITCHEN SINK A DISP <br />I <br />CLOTHES DRYERS <br />I <br />DISHWASHER <br />RANGEHOOD <br />LAUNDRY TRAY <br />W'AT ER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />GA-S FIREPLACE <br />BACKFLOW PREVENTERS <br />I <br />GAS RANGE <br />_ <br />SINK (SERVICE —BAR, ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL f <br />SUB TOTAL S <br />T <br />— <br />PERMIT f <br />PERMIT f <br />TOTALFEE f <br />I <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />I P(IN1 it 1PA!'II iNj <br />PF AP�$FIA/ACC <br />$Id $EIAACA <br />r1 ANC1 C �WjjIP �5 /�_ <br />!F( 9a <br />Prf TIrf NO <br />YSE Toer <br />ION AREA <br />tf CANI VIE <br />'Am Ow <br />FEES <br />VALUATION <br />FEE <br />—�— <br />PAINDWI <br />— <br />L� <br />NiIGN111VIlAlIOV <br />-z� <br />40 d PWEIIING <br />IINIIS I <br />S11E d AIIXVTI <br />Z391 uD S . <br />nINPPIn <br />I <br />OCI:IMAN'.v qlY rliwl• <br />Pdlr <br />Z <br />LIRE rR IERREi'P <br />_ <br />d:CIIM41 lOAD AA. Vr\1 <br />❑II[ <br />PFACryi <br />YIN: RANf4 <br />I(Idil(WAI r\AN CIYCA <br />n1iHR <br />IWfA YPI� <br />RF A[OV <br />41AIf fllxtPwG SIXKUAPGf <br />1rrF CK rovcl <br />—� <br />r1ANx ArrROvrnn.- <br />OAtL <br />CRY OF EVERETT <br />IOCAL SALES <br />TAIf CODE IS 3105 <br />INp41r. wOlY[ <br />- — <br />TOTAL <br />--- <br />