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APPLICATIg1 FOR CONSTRUCIWN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •289.8810 <br />❑ DEMOLITION ❑ COMBINATION <br />nI ❑ BUILDING / El MECHANICAL PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 4& 16LIAAIAFIL,yl"•2.53L 1201k RICK AA,&C e WA.9Ejp/ <br />SFA M2_ 254' 71,51 <br />OWN[N uuuCM[SS Cm <br />MINE u4l.1 SS .11 !iv 1— <br />/.nGBI[CiMCE$IONIn MI.II I'bMIESS CIR )Ir r11P4F <br />GFMGAI COBIAACI011 MxI,DDR[SS CITY OP PUO,IE SIDE IXENSEI <br />IC <br />C.INC[ PINCE OF NpIN <br />HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br />DESCRBEYgRx AND SDUA, !W'WE.N [D <br />e A16ek <br />CONTACi ITnsmA PIQUE NO <br />11 l / <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 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 1 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 />CONT �(1I/S LAAWW.y{Irp 27 RCW AND 296.200 WAG. <br />X <br />`n Sfo USE a RU,tnxr. <br />MWIOESCMPT"Of rnO A"IS1 I1KTOWaIATM.. TBOCMLSI <br />iDT MMK of <br />PAIKIEI TAl I D NOMBER <br />cONsi11UCIKw LOAN I[nDElt Atpnfss. IFIERMINE UUUBFn <br />SgNAlunf [ <br />C11Y SU9NESS LICIENSE ND <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE MIT <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEF. <br />WATER CLOSET (TOILET) <br />A/C—AM:J'JLG UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />-- <br />HEAT PUMP <br />_ <br />SHOWER <br />(_ <br />UNIT HEATERS <br />KITCHEN SINK A P <br />CLOTHES DRYERS <br />DISHWASHER <br />----- —_-- <br />RANGE 11000 <br />LAUNDRYTRAY <br />--- <br />WATERHEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />_ <br />METAL FIREPLACE [WOOD BURNING) <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.) I.J <br />'— <br />GAS PIPING <br />EXHAUSTFAN <br />�IDOM1SIMk' <br />SUBTOTAL f <br />'� <br />SVB TOTAL f <br />PERMIT f <br />Oc <br />PERMIT S <br />TOTAL FEE f <br />'c'� <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />f11CM1 Y1PBCx <br />nEm SEIRAta <br />LCC SEIBACx <br />RAx RgCIt MIMRfO <br />Flf <br />AFCFIPT NO <br />USE ZO f <br />101 ARFA <br />VACANT SIR <br />DIES 0x0 <br />TEES <br />VALUATION <br />FEE <br />- <br />- <br />11[IGIIT IIVIIATgN <br />NO Oi DW[IIIMO <br />UNOS <br />SUE Of BICdII <br />ftUUD IG <br />-- <br />1 <br />I <br />19 MS11q[f <br />GIMUP <br />OCCMPAN[10A0 <br />BASFt1 <br />OANCT <br />DYES ❑Ml <br />M[CIIAMCAI <br />AOGIIKWAIRANCIIIcN <br />I <br />FIIIESPW EGREGD <br />AFASW <br />ODKD <br />FRIEN MREO'O <br />nFA." <br />SIAI[ BIq IYMi SIRICIIAIIGC <br />fln Ix r.ONyT <br />RI.NS"I'mV[DBY <br />DAIE <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE 15 310S <br />RRBX:Vl0I <br />TOTAL <br />— <br />