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APPLICATIA FOR CONSTRUC&N PERMIT <br />CITY OF EVERETT • BUILDING DMSION <br />3200 CEDAR STREET A EVERETT. WA 95201 •25Y-E/10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BULDING U+ MECHANICAL ❑ PLUMBMUS ❑ SIGN <br />PROJECT ADDRESS:_ 1'Ioo �/-le�T MAm%,,,m VLE.w 'OaawE <br />MN ADDRESS an RP RAOAE <br />i[tiµl WA ADDRESS CUT, m PRgIE <br />1DiU1.14A4pra4Y. 41 eM. Lel 5sry r¢T ST. S..IR1! 20 '*769rl , 98101 �2er��r323 - [3L 1 <br />AIgIEi[C1fMi f1[SIWfR YN ARpIESS PM1 /m rygPD <br />3?,0 G albs rr 97r. wNwmTr 23gb2o(_ C2.( ) 259 - 9t91 <br />2" - 22 <br />CITY <br />RANTING CORIRY:IOR MAk AGOESS CIIY ZIP "NORE STATE LICENSE <br />C W I0.1CT RRCE OE MOUt <br />o - oo <br />HEATING SYSTEM: ❑ OAS ❑ ELECTRIC ❑ <br />Cf SCIMBE RO1AF ANO S(1VARE Foarpf MYEAWn L� <br />\N lrOE..V- Aw. /yA'TOl-laTrL F-l[LE SY+wN{Lf[,C <br />1.1AcI rc1150N AIp%gPI <br />S'rsrgy� . NF PA l3 s2 s-csrrE� \I,s 1+-RyTi.� <br />��-„E,J\S FE.000sc �2ot�)92V-22ej0 <br />20��'76 so. Fr' \RATE•...—21t-�'i S�.Fr. F- •I, _ti <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION F L KNOW THE SAME C BE TRUE IN 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 FROWSKTN 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 16 27 RCW AND 296.200 WAC. <br />' D2 / ).stirs to - 3 -q` <br />TNKEoxOIISE a BIRURIO <br />LEGAL M%WTgH or RCFIERP( ISHONN BELM GA ATTACH TNOCoeES <br />LOr K= a <br />TMRCEL TN I D MIIlER <br />Ld5111UCFIOI1 LEW KRONER. ADDRESS. TELEP1gAIE RUNNER% <br />SIGNATURE Io24 �94 MILE <br />CITY EUSRESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF IQLNPV 34T <br />FEE <br />WATER CLOSET (TOILET) <br />AAC—AAINOLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK E DISP <br />CLOTHES DRYERS <br />�- <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 />_ <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PILING <br />FAN <br />-EXHAUST <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTAL FEE 51 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />rnoN,SFTRACA <br />REAR Srisom: <br />eIOE S[IB+CR <br />ry•n C1EC4 NUy1//T R-- <br />Ff F// <br />"'E"" HO <br />USE ZONE <br />_ <br />LOI ART <br />VIC.A41 SIT <br />OYES ❑ NR <br />FEES <br />VALUATION <br />FEE <br />BUIIMNfi <br />NEIOIAT L141T+iqN <br />NJ IXO U.PKi <br />UNITS <br />ellEd BIUG/11 <br />PLUIURINO ' <br />accNVANcr <br />,lgC <br />waslRRls <br />OccIIPANr Io•O <br />aAu.Enl <br />❑YES D NIT <br />Mf I A RAL <br />A11111 U1nAI RAN CRY IA <br />FIRE SPRINKLER RE00 <br />FLA." <br />RIPER <br />RflCNMMREO'R <br />RF ASON <br />(IAIE IR NRSIIIIE.RAWR <br />TYPE aCMsr <br />PLANS ARYwvFn By <br />D+n IG <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 310S <br />nrellr. vRpAAR <br />TOTAL <br />— <br />