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APPLICATIO0 FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT a BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. INA 98201 a (425) 257.8810 <br />L7 DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:N *Ub <br />�5 fl I (? <br />IEN.Nt An ADOACSS Gtr !ro hgNF <br />•D(P.DtcT m DESPOIL. ..".ppnEs% CITY ln' PNONF <br />n IMDMO COW.11.101 NUS/ACALSS cin In, PN f STATE LICENSE• <br />cOnTmct MCE OF MpIA <br />HEATING SYSTEM: VGAS ❑ ELECTRIC ❑ <br />OE ree•,VO.x Aw SOUAn11071wE NVClvto <br />cOII.cl nnsov AID llry lq <br />O T�`.ptE+mot L4d,`11i,3.56'h`/ <br />o- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T41S <br />APPLICATION AND KNOW THE SAME TO GE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHE-,HER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOHIIV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RERI/1 ATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF HIS PROPERTY TO ERFORM THE WORK FOR WHICH <br />APPLICATI IS MADE AN COMPLY WITH THE STATE <br />CONTRACT RSLAW Ie127 RCW 2962DO WAC <br />PnpgstO ME OF emLON T <br />tEGALOEXRIPOOTd V'; fnn(S 81LMLM On ATTACK DIOCOISE5) <br />LOT ROCA ar <br />rAxa 1. I D INITIATED <br />CWSTRU:igN LOAN UNITED ADCAIESS. TELEngKE MMBER <br />scEl a Dm <br />uIY NIVNLSS ICENSE NJ <br />:RLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC—MMDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEALERS <br />KITCHEN SINK IS DISP <br />CLOTHES DRYERS <br />DISH HER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <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 1-REPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />_ <br />PERMIT f <br />PERMIT f <br />TOTALFEE S <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />I.oN1 sE TRACK <br />WAn Sr1AACA <br />SIDE SETRACM <br />n.NcrcQ ryllMltR <br />rtE <br />ftfcf'I SO <br />USE tart <br />lol.mh <br />vACAV PIE <br />FEES <br />VALUATION <br />FEE <br />_ <br />Orts OND <br />eulMMi <br />T <br />IIEgMf 11MII.SigN <br />Ip dpW[IUIb SITE Or eIONTI <br />nNuemO <br />VMI$ <br />OCCaf AY.r Ip nslRes <br />OCCINANT tJAO e1uKNI <br />VICK.KK.I <br />�/ <br />DYES El uO <br />V <br />FIRESMM:LERPEO'O— <br />IFASOK <br />AOO1gNN MIICI..." <br />TOM. <br />rtlq: AIMMRFO'D <br />PEAS" <br />SIAIE eIM1lb4li $1IIKI4ME <br />JIM Of rOVSr <br />nANSAPmpvFner CRY OF EVERETT <br />nmlgwO.AS <br />LOCAL SALES <br />TOTAL <br />—�— <br />j <br />DATE TAX CODE IS 3105 <br />