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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREcT • EVERETT. WA 88201 • (025) 257.6810 <br />❑ DEMOL"ION ❑ COMBINATION KBU1LDBNi ❑ MECHANIC L ❑ PLUMSN G ❑ NON <br />DR PROJECTADEBB: �3 (A), C.A'SINO 2%j yu-2ti�2� <br />BoE)YJy cv. P0, er [ AA s /g r+r Z".3rc <br />I[N•NI uN .1101[SS Gir PP MCM <br />THE /�USrY� (pY}NY <br />ATTCWrrcl OR n[StcW. wu. Aunss un !m Pwols <br />(:b: nlc fl,/:f_ C'nY,,rR✓crla AJ (_ 13 •/- 2(./n --49%) <br />w cmAwkcmIRAC1011 wAM1•CCYY SS flh f.r ng11f %TATF LKINS[. <br />P1.1wM CMI.KTOP wwl Af 15 011 AP Pw STAY LILENL. <br />CONIR•CI PNCF IX WCIw �! <br />Y CID c' 200 <br />HEATING SYBTEM: ❑ 6A8 ❑ ELECTIIN: ❑ <br />Rrscws[.uTW ANn sou..f fbglAAE m o <br />cml.Ct".s MDPl `f() <br />-7LI ,I_ rJ( si/s JC.TU2A(, <br />cc0,vA- 60estl 'tug- rL <br />('cTK A - OE <br />1 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 I AM AUTHOIIC•ED 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 1821RCW ANDD 2/]M/200 WAC <br />X ��y I N� ^ S�� G <br />! ltllIE —v 4A1[ <br />PrvgsfPus[ IX Bq.bN(1 <br />/L4R N VG A- c ry Yt.INC <br />lfGM. MSCWIIpIp MgRRh 151UMN S[LUN OII AIIALw MCOFKSI <br />L01 ROE. p <br />i; [L TA.10 W.A.T. <br />CM%IPIICh kI If"R A MESS 1[lfRIp4 M111MP <br />Gn FbINtSS lCf NS[ W <br />PLUYNNG _ <br />00. TWFE OF NXTURE OR ITEM FEE <br />YECNAMCAL <br />N0. <br />TYN OF NQUPN f <br />RE <br />WATER CLOSET (TOILET) <br />_ <br />A/C — MMNDLG UNITS <br />BATHTUB <br />i <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNITHEATERS <br />_ <br />KITCHEN SINK A DISP <br />CLOTHES OR(ERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />T <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />OAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR, ETC) <br />GAS PIPING <br />EXHAUSTFAN <br />i <br />SUB TOTAL f <br />SUB TOTAL ! <br />PERMIT $1 <br />PER f <br />_ <br />TOTAL FEE 11 <br />TOTAL TEE f <br />FOR OFFICF IISF ONLV- <br />I MM11 [f l.x. <br />RF AR SF 1W. <br />ym ulw. <br />It W AC. NI A <br />fff <br />wcWlw <br />om rowr <br />Im.B . <br />vxC l wIF <br />FEES <br />VALUATION <br />FED_ <br />SU11M <br />_ <br />DIES D w <br />K[ l M1•TpN <br />W dPWFIISfA <br />MIRp NPMI <br />PA <br />yffw.wfAl <br />'l1P•NCI NO N Mlnw[ <br />w c~1 Lm <br />OMKNI <br />DIES DwR <br />-- <br />•Pb10MA1. 1'IW CN[L. <br />fW[ SPRW.L[II RO'b <br />Ilf Alloy <br />y <br />�t4 <br />01 E <br />iNF AlA14(4 <br />KF•FON04544 <br />SI.1[ M.IbNI u.Kw.rcl[ <br />. <br />— <br />l.n Of CUM, <br />nWi <br />CRT OF EVERETT <br />nnir LvnlW< <br />F—T=] <br />A� <br />LOCAL EALEE <br />TOTAL <br />- N <br />VA! - <br />TAX COCE IS G106 <br />wr1 av <br />