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APPLICATIV1 FOR CONSTRUC"N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT. WA 98201 •259-BB10 <br />[7 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: / 7 Z S /" C /),P , 44a, <br />TENANT <br />M NITECI M MSIGNFn MAll+MNILSS <br />uut+GDRlsz (vr !m Mp <br />VECHANNE4 CO IQAEI n MAK AVERT SS CRY !U' MgNF SIAIF IKEMSEA <br />MUMIRMCONIHACrM WM1AI)DRESS blr, ZIP — MA)N[ !.TATE IiCEHSEA <br />Cf TRACI PEACE w ill <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />OF.$CRI�f 7C ANO SQ)ANEr IAGEMvavFG _ <br />t-G /9. IiC c- R>.Yv <br />(INRACr MRSON ANN MAONF NO <br />hl <br />$eqD <br />_�}PPnx <br />I IIERE13Y 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 WIL.. 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 />CONNTTRA ORS LAW 16 27 RCW AND -296/20) WAC. <br />../ / J VE/ -/ � <br />//FLIT <br />vr.d05Eo usE DF eutp <br />LEGAL DESCRIPTION or PI ATY IMNOwe Ill ON A11ACR TWO CDMLSI <br />tot stocl or <br />PAlIGEI r .D NVMY n <br />CWS11111CIKIIIOAN ICN11f q,AMMEBe. iEl[MIOHE NWRFO <br />PRINAMm DATE <br />CITY DDSINE$$ IILENiL Iq <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />fEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ANC—AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN 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 />BACKFLOW PREVENTERA- <br />GASRANGE <br />SINK (SERVICE —BA ETC.) <br />GAS PIPING <br />_ <br />i <br />EXHAUST FAN <br />SUB TOTAL $ <br />SUB TOTAL S <br />' <br />/ PERMIT S <br />PERMIT S <br />�— <br />TOTALFEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />f RVN15[TR+fe <br />RUn SF1R+C <br />SIDE S[1B <br />MAN CNCCRMWBER <br />EEE <br />NICE.,,w <br />3'1/ <br />USE ZONES <br />IOIAmA <br />v+tANI VN <br />F S <br />VALUATION <br />FEE <br />lPNG <br />0000 <br />J 7:. —' <br />�' <br />❑r[s ❑Ml <br />NERN11 UMITAT0. <br />HO a DR,tallAI <br />SIZE <br />E Or NU. <br />MDMRING <br />I <br />MITI <br />DGcnM'A 7(S <br />MCUTAN1lG <br />A❑YNS <br />MrnMNc.t <br />' <br />r <br />u s— <br />ADDIrNINµ MAN OYd <br />7lJ <br />RRESPRINNtER o9 <br />REASON <br />ObttD <br />Al <br />rim AIARMA V <br />REASON <br />/ <br />STATE B.AIMMI SIMNM.GE <br />1rrN oro .I <br />MANSA, nry, <br />CITY OF EVERETT <br />MM..P.wRIIAs <br />/ N <br />LOCAL SALES <br />TOTAL <br />----- <br />----- — <br />DMe lG !I <br />TA%CODE IS D105 <br />Vy, o <br />