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APPLICATAN FOR CONSTRUC�ION PERMIT <br /> CITY OF EVERETT•Bl11LDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •257-8870 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECTADDRESS � <br /> / 7%fJ .�/��'s� <br /> " /%�+�w s � A��2'Q�� zw wror� <br /> ' YNLMOFESS CI IIP p��yE — <br /> fnC111iELipf10C5GNLi MAp,ADpPESi CIIY IP RIpNE � <br /> fENCMlfAfliMCiOF MAILAOpRE55 �Iry Im <br /> %IONG SiAiEL4ENiE• <br /> IJLG4NiGLC01IIPALiOR M�IL�ppqE35 LRY Z�p <br /> P���F SiAiEl6EN5E� <br /> f;uuOFlGCOIRMLIOR H�RADOFE55 CRT ZiP <br /> FNQYE Si�iE LILHISE� <br /> CONIPACT PRqE OF WON( <br /> HEATING SYSTEM: ❑f:AS ❑ELECTRIC ❑ <br /> �[9Cfl10E WOIIN NIO$WAPE FW GGF INVpLVEO CAl1iACi pE{I5011 Rlp PNOIIE NO. <br /> . I HEREOV CEflTIFY THqT I HqyE READ AND E%AMINED THIS <br /> i°��oaoSEousE or em�drq APPLICFTION Ad0 KNOW THE SAME i0 BE TRUE ANO CORRECT.A�L <br /> PROVISIONS OF LAWS AN�ORDINANCES GOVERNING THIS NPE OF <br /> imn�o¢scnwiiCr�ocvrrop¢qtt�5uowqaetowoBerucnmro:,pvi¢s� �VORN WILL BE COMPLIED WITM WHETHcR SPEpFIED MEREIN OR <br /> NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME W GIVE <br /> �O' —eLOCK ar AUTHORITV TO VIOLhTE OR CANCEL THE PFOVISIUN OF ANY <br /> OT,k1ER STATE OR LOCAL LAW REGULATING CONSTPUCTION OR THE <br /> PERfORMANCE OF CONSTPl/CTION.THAT I AM AUTHORIZED BY TI1E <br /> OWNEF OF THI$ PROPERTV TO PERFORh1 THE WORK FOR WHICH <br /> APPLIC B MADE AA I CO�dPLy W�TM THE STATE <br /> re,�cnurzioriuueEa CO T 5 W18 CSNl�qD296200WAC. <br /> LOLStnlIQ10rILJWIEN�E0..NDFE55.TFLEPNONENU4B[q _�r--3-1��� /0��� <br /> Sq�� OAiE� <br /> 'v"OUSixE55li;ENSE N0. �' <br /> VLUMBING MECHANICAL <br /> N�. TYPE OF FIXTUqE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILF.T) FEE <br /> i !JC—qrHNDLG UNITS <br /> BATHTUB ! FORCEDAIRSYSTElAS <br /> LAVATOP'/�WASH BASIN) HEAT P�JMP <br /> _ SMOWER UNITHEATERS <br /> KITCHEN SINK 8 DISP CLOTHES ORYERS <br /> OIS�iWFSHER RANGE HOOD <br /> _ LAUNDRVTRAY i WATERHEATER <br /> CLOTHES WASHER � WOOOSTOVE <br /> URINAL METAL FIPEPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSEFT(WOOD Bl1RNING� <br /> _ FLOOq DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENTERS GAS RANGE <br /> SINK(SERVICE—BAR,ETC.� GAS PIPING — <br /> EXHAUSTFAN i <br /> SUBTOTAL $ � SUBTOTAL E <br /> PERMIT S i PERWIT — � <br /> S i <br /> TOTALFEE S TOTALFEE 5 - <br /> FOR OFFICE USE ONLY: <br /> fPO�liSEIDa�K IIERRSEipACK SiO[SE1B/{N PLWCIIECNNlIYOE <br /> iEE n[CflvTuO <br /> usezoriE �mnn[e vee�.vrSrtE FEES VALUATION FEE <br /> ❑YES O NO BWLDING <br /> rvE�GHIli411LiipN IqOFpKELLiNG SIIEOFpIDGRI. i <br /> uwts - <br /> rwuenuo <br /> OCLucu1CY AVOlSiCartS OCCUP1xil0A0 MSEUFM <br /> GPWP 4ECIUN4Rl � <br /> ❑YES ❑NO I <br /> fAESPppIxLERPGOU REASON - MCIiNNALP1µLMECN <br /> FlREeUqNpEOD PEISON OiNEN <br /> ^.TAIE�WLOiNG SUNCHMGE —� <br /> LYPEDGCONSi. PUNSAPpq0VEO0Y <br /> qTYOFEVERETT vueicwon.s <br /> . LOCALSAIES <br /> on¢ TAX COOE IS 3105 TOTAI <br /> . ay -�' ..�.✓�� , -- :fll�ii'i�jl1 <br /> :�, � y ,, N�^� yt� 1 .� <br /> T <br /> t r �`� `'� "� f f�': �t� <br /> _ r�,� �-. r,�r,y�y x.,u �r ` � �}�' ��. <br /> _ _. � t.���i�: <br />