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APPLICATIOW FOR CONSTRUCAN PERMIT <br />CITY OF EVERE17 • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING 14 MECHANICAL ❑ PLUMBI l ❑ SIGN <br />PROJECT ADDRESS: 0-\ W, YYLcr-," II (-E11P <br />tMARR W.LAGMESS GLY m M4( <br />,-A( (vcslCov; 1a 0 U1, v '_[y � \l Ave U2dlxQ PLF �py 4a �- 353-al17 <br />I[." W mnoAwss Ell, IM PIONF <br />ARCM. C I GPMVGNEP WA ss <br />fAMR4 CGV1PAC1Cq <br />Mut AUw1(F�5,5 <br />CITY <br />!R <br />MgYE <br />C41E lICENSFI <br />i�ir�KVY>u U�nl: <br />f'o, -foi.S \V, <br />�Lbai•(c¢,1 �a�Cc <br />(�r. �citf <br />nll ("!1 <br />�GAt_l}1FN-KK�.i�p <br />M E .C4 CO , AClm <br />MAq 5s <br />CAN <br />llr <br />SIAtF LKFNSE• <br />',�Z,sw <br />016,;- <br />AIIWIMGCCNRAf.TOR <br />Out AtN1<ss <br />CO, <br />1" <br />r F <br />STATE LCENSEI <br />CWIRAf.1 PLACE Or NpN <br />HEATING SYSTEM: ❑GAS DIELECTRIC <br />DESCRIBE Wwb(A4p SwUA1Rf�POJIAGE MVQVFD 5 <br />1. LDNIA/C1 ryRspl AND MR}R Yp / <br />\l-1. <br />O <br />I HEREBY CERTIFY THAT 1 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 />WORK WILL 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 THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO FLRFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW IB 27 RCW AND 296 200 WAC, <br />X B <br />PRonosfD usE DP LwNn <br />tFGAL VEscwPlloN OF M RM ISNDWN WtOW DR ATIACN TWO COMES) <br />Lot BIGGL DF <br />IMICEL TAX I D MA n <br />CGNSIRICIgNIOW IFM1fP. I1[IPESS RIfMCIIEMMIFP <br />$IfiNAIDIIE pAIE <br />GTT N151MFSS ICFNi( NO <br />PLUMBING <br />MECKANICAL <br />NO. <br />TYPE OF FIKiUIIE OR ITEM <br />FEE <br />NO. <br />TYPE OF IIIQIIIMJD/T <br />FEE <br />WATER CLOSET (TOILET) <br />AAC—AAMDLG UNITS <br />_r- <br />BATHTUB <br />FORCED AIR SYSTEMS <br />± <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWEP <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />VRINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />_ <br />_ <br />SINK(SERVICE — BAR. ETC) <br />GAS PIPING <br />EXHAUSTFIN <br />SUBTOTAL $ <br />SUBTOTAL S <br />PERMIT S <br />I <br />PERMIT S <br />_ <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />I Rf1Y!V TPACK <br />RIAR CE I IIACR <br />sax( uwA <br />r1.WC11FCNNLIWR <br />IF[ <br />MCf IrI NU <br />I'll Z0`F <br />_ <br />IOI AM A <br />vmwl AlE <br />❑rFs ❑ I+D <br />FEES <br />VALUATION <br />FEE <br />BIPIw <br />—�_ <br />14IC.11I 11411A1gN <br />NO Ur IM'IIIIMi <br />iYOS <br />$1(fM9lW1I1 <br />MIIMIMf <br />— <br />IX:lIMA41:Y <br />l:l1011r <br />4�r1 al.ni♦ <br />CICFIIIANI IUAP <br />BAS[M[N\ <br />❑K[ GY'f <br />WI;NA41r.A1 <br />APw IHWM. MAN CHICK <br />--- <br />FWESMINKIERAEOD <br />_ <br />I A[CM <br />U1N R <br />f IRC AIARM R[UO <br />P'ACOY <br />[MII P�PIUMI: SIHICUARf.[ <br />— <br />I IN of CON" <br />MAYSArrnovfn BY <br />nATE <br />CRY OFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />11M1,r.WMIKR <br />— <br />TOTAL <br />- — <br />-- <br />