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APPLICATI& FOR CONSTRUC*0114 PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERFTT, WA 1 0 <br />269-6810 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING HANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: I7/[; I,/r-Y W.4e lyz: ��Yt� U\MECL <br />TA4,1 Qo 4.[.r <br />TEIMNT PM ADDRESS CITY IX' aq.( <br />M TECTONOIS0WHA <br />WX A7Sf <br />On <br />M' <br />RIL'Ii <br />Ci -,T, <br />sit? L161Mt <br />EL <br />OENEMI CURTR.CTOR <br />YAMCIIE" <br />dlr <br />lX• <br />n-]lnlli SIATLIIC[NN. <br />�r.I'F::lf l✓u+t <br />pp <br />yNl J•.IXY IS�f,- <br />FL-f" <br />lily+ <br />Zi F-.l!/y [['Y1L-GS-S [71K7 <br />AdIANICAI CONTRACICII <br />TLVI ACtIIIss <br />an <br />tr <br />Rgrrt STATEIMAISE. <br />MU4SMGCONIPACT0A MAAOOMESS CITY Ell M1gA STATE ICENIfA <br />CMTRACT Pi11Cf OF YA1Nt <br />I1EAI INO SYSTEM: bl L3AS ❑ELECTRIC <br />CEFdSSE W01Fl ANo SWAPf EOOIME MYCIVEo <br />CIMIACt KA9MANl PIq.E NU <br />1 HEREBY CERTIFY THAT 1 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 />CUNTRACTORS LAW 16.2T ACW`AAN^D 296.200 WAC. <br />X _✓ J'Y- F[ <br />PrgPos[OIKE SIROXIU <br />IEOAL OESC MOF PROFEA\Y INOFM MOW OR ATTACH Two COPIES) <br />LOT NOCX Of <br />MI1CLiTA 10 MIIIISER <br />CONSIIIICTIgILOW LENDER. AOgI[u lFlF1'Ig1t MRNIFR <br />�7 <br />sAw TIRK wTF <br />do SXISW459ICFNS[ NO <br />PLUMING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />ND. <br />TYPE OF EOUW%NW <br />FEE <br />WATER CLOSET (TOILET) <br />UNITS _ <br />BATHTUB <br />_NC—MMOLG <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH P %SIN) <br />_ <br />HEAT PUMP <br />SHOWER <br />_ <br />HEATERS <br />KITCHEN SINK t DISP <br />_UNIT <br />CLOTHES DRYERS <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER NEATER <br />CLOTHES WASHER <br />I <br />_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (Wn�O�O�Dn BUM NING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT WOOD BURYING) <br />W <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL f <br />SUBTOTAL f <br />PERMIT f <br />i <br />PERMIT f <br />/,S 1 <br />TOTALFEE f <br />TOTAL FEE f <br />75' <br />FOR OFFICE USE ONLY: -- N.3S9 <br />FIIdTS[TRACK <br />IYASFtSACX <br />s1Uf SETBACK <br />m.rl[rX 1A n <br />r[f <br />rcC[X't No <br />USE[ONE <br />IOIAAFA <br />YACAN\WE <br />FEES <br />VALUATION <br />FEE <br />_ <br />❑YES O TATBVI1 <br />IIEIGIII VIn1A1gN <br />NO OF IIW[tIINO <br />alF Cf RInC✓11 <br />IMIIS <br />ry11uRM <br />OCCUPANCI <br />Gfl01F <br />N] nflUplf <br />OCCUPLNt IUAU <br />RXSFANI <br />4Fd1AMC4 <br />GY[S ❑ Nn <br />RI%XIXINAI IY At.IX rX <br />_ <br />fIOE S%Y1Ml[fl PC09 <br />Pf Ai(W <br />uuNn <br />I"N MAEG A <br />nE XStw <br />l\Xlr RIXII WN: SIXIf.I WNIE <br />TYPE Of r.ONSI <br />PIANSUPpvfnnv <br />CIfYOFEVERETT <br />vryl <br />LOCAL SALES <br />a ('/ J <br />TAA CODE IS 3105 <br />TOTAL <br />OAIE <br />