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APPLICATI� FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT B BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 IT (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ��� G✓f s "7,c. ,e „„ c [/, E-./ <br />^� -- - /7/,1 4,JMa0 4,14 1`.E_Z/ ZSwJ-3iG / <br />Ancm clrnnEvcNEP uu1 uBlRf ss cnr nr 1'.KYil <br />pr 1MLIp1 4.n .DMR SS "M1 )R � $MII1Kf NSf ^ <br />CoAyAv _Au oL.o"c <br />Ni C111NILIl CDV1n1CI0n VNI .f%PF 55 MiV !rt' Ir,CNI tIAIFD ENSE+ <br />CS bec} e,-19-9Sf___ _ <br />MU4BMG Cpllu.ftp1 Out Ep+lE55 PII lin r.�rnf suILIK[a5f• <br />CONDI.Cr I"i OF 5 d 0,5067 <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />p SCMBf API fDOIWF NVJIKD <br />CCNI.Ci PI PSfM.M 114MIf NO <br />Z ti.Q t` 0— C 1- 2�:_ <br />I HEREBY CERTIFY THAT I AND AMINED HIS <br />APPLICATION AND KNOW THEI SAMEETO BE TRUE ANDxCORRECTTALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK Wit 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 15 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10 27 RCW ANp 296 200 WAC <br />r✓/�� <br />rMK`osfo vsL p BUAMND i� <br />LEDAl pSLP Irconp rnlK`Enn nNomleuow� mCH IxOCMt_SI G <br />for BtocaE'er <br />� � <br />Fw[CCi ru 1 D MrvflF n <br />t ONSw/T •/� P. /L'(IPESS. itl[r'IgNE MNPiP <br />OTTE <br />CITY BUSINEssl[LNsf NO <br />PLU <br />BIND <br />MECHANICAL <br />NO. TYPE OF EOUIPMFNT FEE <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />AAC—A`HNDLG 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 />I <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 PREVENTERS <br />GASRANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />- <br />EKHAUSTFAN <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTALFEE S <br />TOTALFEE S_ <br />/1ee1rO .cc nut V. <br />I TIM, vrn.Ltl <br />nnR SrrnACK <br />SIDE UIRAC. <br />M.x Clrtca MpNMrT <br />of <br />rtr <br />v <br />ntLnrl eo <br />USE ZpIF <br />rOI APu <br />v.CANI v¢ <br />FEES <br />VALUATION <br />FED_ <br />_ <br />ry114nINf. <br />4f1:NANCAI <br />-- - <br />DYES 0No <br />NEKINI TWAT" <br />NO pDWEtt,NG <br />IIMIG <br />SUE OF <br />CCnpM AM:Y 41MSIM1lf <br />p:Clrn.xl lOAR BASf MENi <br />S OI[s No <br />MIE SPPI,IMI[RPEOD <br />Nt.G(W <br />C'�'IbTMU <br />AOpIKWN MAMCIBCN <br />olIffn <br />FINE �I U`m PLOD <br />I.ID', <br />�„p /N <br />SIAIE RUn MT511RCIAl <br />yJ <br />rYM OF cplsl <br />ruN5.vlwovFDA, <br />CRY OF EVERETT <br />ninl K.xalKs <br />__ <br />V —XI�L <br />wR s/ �' <br />LOCAL LES <br />S 3105 <br />TAX CODE IA <br />TOTAL <br />IZO �Q <br />