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APPLICATION FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET EVERETT, WA 98201 A (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION P BTAUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS:_-J-C2/C I%OGG 9AA/I (-� ��'�RP% T 9•�20/ <br />TC/iZRY DAGEr-r - lAf4-- Al ABrcP <br />EDIFIED I ARD AUUR`,R1 Clry tlr rlgwf <br />1EM.N1 NN ADDRESS fRY Ilr rMYF <br />APCNRCI On DELGMn MRK ADDRESS Ell )m FR <br />/RaC%GL/J! �'O 3G? A&Arf"A <br />EINY <br />Ie-&C�Y7 <br />A17=9dBYO <br />oNlwRPo�IIAroREss <br />WCNRNICALCON1r1.LrOP 4111.nDUI ell )Ir IMNF [I.IF IICf N[f. <br />MIIYRMGC NRf AIPI ADDRESS / 011 Ilr IK}+f Si11F tICf NSF0 <br />T <br />HEATING SYSTEM: ❑ GAS DIELECTRIC ❑ ___ <br />KunIeE IRMR AID W11.nE FDOIACF JRMWD <br />CORUCI nnSCw <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 />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 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND ZM 200 WA.0 <br />� fly-, /\ l,.�j <br />-L1` ! <br />rPppSFDU� or e"Am <br />d 0EA /YT4 TD 7 <br />tEGALMSCPIPTIMO A"I RELOIORAr1ACNlY CMtSI <br />Lot _1'10/ L�j BLOCK JYy DE 1/eAc?-7 D/U Ci <br />GOJN / <br />(' <br />fwlcn rAKID rAAwfn Y�f6 3�yy O09'•000d <br />CMStnIICiNINIOANI[NpfR. AOp1EER5. lElEAIONEMMIfP <br />t <br />X4 <br />S.GNNUIE OAIE <br />C11Y RU4NE :S lCl Mt[ NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ARC — AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHLN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />DACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL S <br />SUB TOTAL S <br />' <br />T <br />_ <br />PERMIT S <br />PERMIT f <br />TOTAL FEE 5 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />MORE SfiPACR <br />USE IMF <br />uHOIa I' fA`ION <br />OCCITRN.r I11 D151fn'l5 <br />GP <br />SPNINAIER no, <br />FIRE HARM PAGE <br />rrMDf I'DNRI <br />RfN 5f1nRCK <br />musEA: A <br />SIDE SF (BACK <br />v¢AwSUE <br />OYrS <br />rtANCIRCAwwrn <br />FEES <br />70 <br />_PTrEUT NO <br />FEE <br />-__— <br />�1 <br />387— <br />No OF DWfIURG <br />INII <br />SIZEIEDG 9I <br />ruNnMf: <br />OCCLIPANI WAR BASF%NI <br />OYES D <br />4FCNAAAAAt <br />ApgEKINRII'I RN CIRCA <br />. <br />MASON <br />ORDER <br />REASDN <br />SIRIE RDR DID SINCIIRRnE <br />nRvSAnrwovEnor61 VT <br />DOL '� <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />rylllr.IDnKs <br />TOTAL <br />