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APPLICATIA FOR CONSTRUC1*10 PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING IK MECHANICAL ❑ PLUMBING F SIGN <br />PROJECT ADDRESS 4175� R V cx m AYE' • / <br />`r0.EV10U51.4 k.f•C- <br />OY(AYER MA'L AWI 11 <br />_ <br />I,...,.,,. Bali-'An"T ANIe M"'IMuo: 961-10 NO 659 b531S <br />3 AMIE <br />ARCHITCCTORDESIDNER MARADMES5 <br />CITY <br />ZIP <br />RKIIE <br />GENERy Ld11RAC10R MMl ALOALss <br />CITY <br />ZV <br />P,ONE <br />STATE LCEIRE. <br />MECHANICAL CONTRACTOR MALADENCSS <br />CITY <br />Zw <br />P.q1< <br />IIIIS <br />STATE lKC16E. <br />21LL7 <br />\tx5o� MF4•TLHI <br />2D211 CcMaYAAACT W, <br />lV+�� 9i01�. <br />53511 <br />EAic•k1� <br />RUMO.N] G'JNiRACTON ..Ai ALV'NCSS <br />CITY <br />IV <br />dg11C <br />ITATE LCCNSE• <br />coNTI cT PRICE o<xgr60 <br />HEATING SYSTEM: fI GAS FI ELECTRIC F <br />OESCA BE xONR MYJ EOUARE FOOTAGE MOLVED <br />T A C L N00 S <br />CCWTACI PEI,SON ADDN D gNE NO <br />On 0.H4 M. CR o <br />4-4s <br />I HEREBY CERTIFY THAT I H NE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE STME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORD,NANCES 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 />APPLCATION IS MADE AND I COMPLY WITH THE STATE <br />CO TRACTORS LAW 18 27 RCW AND 296.200 WAC. <br />Pnagsm use aeuLomD <br />�T <br />,TA11M <br />LEGAL cesCRwT10rvvnrattrTV lsHoxN nuow DR ATTACH Two conlEsl <br />LOT A BLoc4 GE <br />%wTy, P*w im 10 qm&tt bw - DO <br />LOT 1 1 }I(� <br />r.PccuAB ID NUMB[n <br />00SB2.1O%1013G0'OOSSLI°ISOISOU <br />WISTRUCT"A LOAN CENTER AIXNP6l1RCVH0NE INMOER <br />X�1 1,4 <br />S*NM E DATE <br />CITY BUSMESS CCENSE DO <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 />AC — ATINDLG UNITS <br />i <br />BATHTUB <br />FORCED AIR SYSTEMS <br />1 <br />LAVATORY (WASH BASINI <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />i <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />I _ <br />DISHWASHER <br />RANGEH000 jfnVjl - li•R <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE(WOODBURNING) <br />i <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT IW'OOD BURNING) <br />FLOOR DRAIN <br />' <br />GAS FIREPLACE <br />' <br />OACKFLOW PREVENTERS <br />1 <br />GAS RANGE <br />i <br />SINK (SERVICE —BAR, ETC.) <br />i <br />GAS PIPING <br />I <br />Z <br />EXHAUST FAN <br />I <br />i <br />i <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT 5 <br />TOTALFEE 5 <br />' <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FINMII ITT... I REAR: <br />vACWiSOE <br />❑YES OIX! BULdNG <br />MJDO aD,VEILM] <br />"CCCC DC BIWYE <br />M <br />I'CNmIN3 <br />CC,T~LOA) <br />BASEMENT <br />MECHAMCAL <br />❑TES ONO <br />REASgI <br />ACOITg PLwdICCT. <br />OTNCR <br />PERSON <br />STATE BUILDING SMPCHLP4E <br />PLANSAPmy eY <br />CITY OF EVERETT <br />PUBLIC xCPnS <br />..... ty /'Y <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />CEE <br />