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APPLICATIA FOR CONSTRUCADN PERMIT <br />CITY OF EVERETT E BUILDING DIVISION <br />3200 CEDAR STREET P EVERETT, VIA 98201. 2694810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING , D MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: %%4Z%lA,�xI /(.C� /✓ii� <br />IIIS ADb1[SS Pn !IR p4{ <br />LL)2}i- r. <br />YM IiDUCSs Un llo p,p1F <br />cldoqu <br />1 DF YN 5 Un /R' p1YF <br />OE i14CIDR /I Y.N MOIIf 55 [IIY TI' pAw STATE INCENSE• <br />imzb/ <br />CNEMCN CONIRSCIM 4Nl AODIIEfS CAn llN` pNMF GIVE IICEM4l <br />ft uM.G CMTWTM uAt SS CNn NIP pUNF STATE INCENSE• <br />CDTWT 14AAM w rlDTw <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC 0_ <br />GFSCME WJIOt AND SWARE iODiIIDF INVpVED <br />CIH1ACi NYnSW NO R\Y41q <br />A <br />I EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ICATION .%O KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERIMND THIS TYPE OF <br />WC RK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NO.. 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 W THE <br />PERF OF CQHkTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNE OF THI OPER TO PERFORM THE WORK FOR WHICH <br />APPL ATI IS MADE D 1 COMPLY WITH THE STATE <br />RACT LAW 11177 AND WAD. <br />X <br />morosEG usE w <br />IECAL OEswPrlw a FNTaEAn ISNDAN KIOYF w ATTACK rno C SI <br />lol eLoctt a <br />INCEL IAA NG ININN[A <br />GGNSrnIA;111L11GNI LEICFn. AGdNss. TElErsgNE TAAAnEn <br />R wlf <br />Un lESSlCENS[NO <br />PLUMING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTUIIE OR ITEM <br />FEE <br />NO. <br />_ <br />TYPE Of EOUMPMlINT <br />FEE <br />WATER CLOSET (TOILET( <br />AC—AAINOLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK L 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 />+_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT S <br />PERMIT f <br />_ <br />TOTAL FEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />1n 1WAACA <br />RkN.iy ACN <br />SIDE SE1wCA <br />M1ANCNCCSMMrn <br />IfF <br />R[('FIPI MG <br />USE 7DNE <br />NEIGIVOAAI.T N <br />CCCU1`AKY MJ (N SIMIS <br />GgF <br />FIRESMNKLERnEDD <br />FIREALMMREG'D <br />SrcE DF".DHSS <br />Iol.mE <br />vACANI Vic <br />❑vFs Ow <br />FEES <br />VALUATION <br />FEE <br />{ <br />MADIMfi <br />ATOP ITYEILIN6 <br />INNING <br />SINE 01 llDMI <br />M'w. <br />IX:CIFAM1lOAD <br />IAYUFNf <br />❑rfs OND <br />4ECMNALN <br />Am I?MIAIpANCNICII <br />nFAiO <br />OINKn <br />RFASON <br />STATE SINK SIIRCNAWE <br />PIANSAP WDar <br />wlE <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />NAT,-. wcvTKc <br />TOTAL <br />