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APPLICATI/f FOR CONSTRUCION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •25B-B810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING /�❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: /�_�) �/,�,,r„t,�p bL /h/ <br />DENE1w CONIMclm u A[WIEss Lnr ---� IIP_— ll M 51.1E t"1 F• <br />INq SUN LCENMA <br />coNlRAcr rRlcEv <br />� �y <br />11EATING SYSTEM: ❑GAS ❑ELECTRIC [IDESCWFE <br />MVI1M ANp ARE ECO1bE HVCIVED <br />L[M1I(:1 V[ItsfNl Ak11 P11pf ND <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 DOF5 NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGLAAT'NO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WRMCH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 2%200 WAC. <br />X <br />vRorouD USE a eulLowa <br />LEGAL DESC TKIN OF 11" I91OWN KLOW DR Atl C"rWO COWESI <br />[O[ F[ q <br />vAACEL rAF I D. Nlluun <br />C S111U TI LOUT IENDER. ADDRESS. rf1fRIDNE MIMIEn <br />_ <br />SNn1.1UAF WIE <br />%SLCFNSENO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE - <br />_ <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOIL ET) <br />UNTS <br />_ <br />BATHTUB <br />= <br />_MC—MINOLG <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <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 PREVENTERS <br />GASRANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL S <br />SUB TOTAL f <br />100 <br />PERMIT f <br />PERMIT f <br />/ 100 <br />TOTAL FEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FRpl1, InACK <br />1114R<rl"CF <br />SIDE Sf TsAC� <br />I <br />'IF <br />nEfFMTNO <br />USE 1w <br />Im AREA <br />vAUN15nr <br />F ES <br />VALUATION <br />FEE <br />DUtI1MM <br />❑vFs ❑ ND <br />HEIGNI IIMIIATION <br />Na OF DW[EFING <br />54EMUDG4. <br />UNR.< <br />r1114nIMj <br />-- <br />CGUnANCr <br />MJrysIM15 <br />ANI IOAG <br />CCCUrGn <br />FASC4EN1 <br />4FCIIAN'^.A1 <br />❑v[5 ❑NO <br />ADDIIIDNAI N.NCWCK <br />— <br />NRESPR:NKLERRF00 <br />RF /spY <br />DUKn <br />FIRE AWI4 RED <br />W[ 10 <br />[lAlr R.R Wl YKV.IUMI[ <br />T,FF or Lovsl <br />ryA45 Arm1ovrn Dv <br />CITYOFEVERETT <br />nlmlc wnu< <br />LOCAL SALES <br />- - <br />—- <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />