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APPLICATION FOR CONSTRUCT BON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS �J'1=LECTRIC ❑ <br />259-8810 <br />1 1 DEMOLITION lu COMBINATION I I BUILDING I MECHANICAL I I PLUMBING I I SIGN <br />CRANIA UAL ADDRESS <br />(iULLOLIJ cflY m / g11E <br />A/S/L a 6"re"N-//tdr^7/ — , ,> <br />TENANT YAI SEERESS CITY ]m <br />nI1CMrEtr qI OFSDNER MAE.AEOIIESS CITY xm r'IAMX <br />OFNFnAL LON1nAtlal MAR ADPAtSS a" 7m npl2 SIAIEIDCNSEE <br />/U. Ir. eA�DA'I't v <br />MrO1ANCSC CCNIMCTM MMIAREACSS CITY 11 mart STATE LICENSE• <br />lVARIMCMRA&CIM 4At ADRCSS CITY 7m MDI2 SIAIE HCCNSEII <br />I I NEW 1 <br />~1 1 ADDITION I I ALTERATION ,�-FEPAIR I LOEMOLITION 1 I WOODSTOVEIFRPL INSERT I I BUILDING RELOCATION <br />ExwlnAcr rnlcta BDRx 'GG CI <br />cwtAct rtnsal nrmnK%TF TER <br />-7r <br />P' AIFAI AAND SCUA;44GE My iIBI I L'Cti <br />$g�_p,Yg KIZ•v+ /L.1 /{YSD_6i - ffiAlL'tEA <br />`_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS,P�G46v6O <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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. N/E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TI/E PROVISIONS 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 PROPEIITY 70 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW fl27 RCW AN0296.20G WAC. <br />¢wltrtscnlrtwarnortnry l51AbN1Bnowon nnAGlrl%EIdJrEsl <br />LOT &ccA Dr <br />SiX TiG.v ?u lWh/1[n� n QT <br />FL FT- t—af, �i2a /' <br />7A My� /57 Arp T& LL/ /JI.: F%' S <br />70 35 7-1d C_ L?—ll-7k/� 6—�. oi3 <br />nTo.rtcl Aooatss <br />wR <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AR)—A4INDLG UNITS-11 P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.TU M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.TU. M <br />SHOWER <br />CLOTIIESORYERS <br />�— <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />�— <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE B CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLGW PREVENTERS <br />GAS PIPING <br />i <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC) <br />SUBTOTAL S <br />ISUBTOTAL <br />f <br />PERMIT $1 <br />PERMIT f <br />TOTAL FEE $1 <br />TOTAL FEE f <br />�— <br />FOR OFFICE USE ONLY: <br />nDNT SETBACK <br />REAR SETBACK. <br />CDT, SETBACK <br />MAN a1ECn MNBtR <br />7 <br />EEE <br />ntcClrl No <br />USE 7DNF <br />LET AREA <br />WWI SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />1'LUMBRID <br />tMOTCPI1S NLONMI <br />ItR aCP151 nC1114 <br />AprNr:r <br />gntMUKIn.It <br />SIIEaBH1E <br />KO MSNMES <br />BASEMENT <br />MECHANICAL <br />ADDITIONALPLANCH CK <br />ECCIMINCYUC D rRE WRAUERS RFE9 MKIMILWA1DN <br />REASIlN Ea15rRNgERe <br />5^RINNIER <br />STATE BUM1DING BURCHAOGE <br />�� <br />MTAKE BY <br />MnNSAImroeYo nr <br />CITY OF EVERETT <br />LOCAL STILES <br />TAX CODE IS 3105 <br />PUBLIc wwKs <br />TRIAL <br />