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APPLICATION FOR CONSTRUCTON <br />CITY OF EVERETT P BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 •259-8810 <br />f9 DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL <br />ADDRESS:- yal �lr <br />1F~ UAK 4%MIISS <br />IN <br />AnnBrzn On DEsbNEn uul AnnP(ss CITY, ZIP PNDNr <br />PERMIT <br />❑ PLUMBING ❑ SIGN <br />CEWRH CONTRACT011 VlI1 lnMP SS CITY ZIP n10N( STATE IK(NSEI <br />NECPAMCAICONInAC7M YAk,IMMSS CITY ZIP "OI,t STATE LICENSE. <br />PIVMBMG COnTPAGIpI MAIL ADDEESS CITY ZIP PINE STATE ISENSEI <br />CONTMCI nKL OC Wp11R <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CfSCM1SE NOFI I ANO SOUANE FOOIbE 11PKAY1E0 <br />CWIACI M IT"ANp PIbNE lb <br />1� <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 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 HCW AND 296.200 WAD. <br />X <br />PPOnOSEODA R euAdlq <br />LEdLLOESCRPOd or morcntt Tv IKLOW OR AOAOIiwocpprtsl <br />L07 > ��' elacs a ,(b'f <br />PARULIwD IAMBER <br />S y c=oy Gis" ccc <br />CONSITAICTKNIOAN LETmEn. ApORE55.rzIE1VKYIE KIAAe(n <br />SIGIr UT1� F I Ob[ <br />CITY RM"ESS LICENSE Iq <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE. OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />NC—AAINM UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SIN( A DISP <br />CLOTHES DRYERS <br />_ <br />DISHWASHER <br />RANGE 1400D <br />LAUNDRY TRAY <br />WATER HEATER <br />' <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 />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT s <br />L)TAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />I'MI F1PACN <br />PCM SETBACK <br />SIM SEIeACK <br />PI A. DIEM TNMCP <br />fff <br />PfCPPINO <br />ME lOrrt <br />101 AITEA <br />VACANT VIE <br />FEES <br />VALUATION <br />FEE <br />DYES ❑ NO <br />RUKDPIP <br />j <br />TrtbNl IANMibH <br />NO Of Dn4llIN0 <br />SIZE W SLIDER" <br />uwts <br />PP.. <br />R <br />ILpml LOD <br />4 <br />y(CNAMN <br />I <br />❑TIS DNQ <br />ADP IMP, M1 AV CNF" <br />I'm SPWMOER MOD <br />IKASON <br />011" <br />TIPS AlAR4 RED <br />REAiDN <br />STATE BIPIVIMII SIMCIIAME <br />TYPE OE CONSI <br />PLANS APPROVED BY <br />CITY OF EVERETT <br />nml K. vroPK6 <br />LOCAL SALES <br />TOTAL <br />— <br />j <br />DATE <br />TAX CODE IS 3105 <br />