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II <br />I APPLICATIA FOR CONSTRUCAN PERMIT <br />�* <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET B EVERM,, WA 98201 B (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />7 <br />PROJECTADDRESS: 502- .331 <br />® 4VC W Pyeiea Wm y2e3 <br />1ENA" <br />4A11 AnpNFSS <br />fl\r <br />]Iv <br />`, T <br />owueh <br />ARCNIFCI DB DESPIDIP <br />ImnRFss <br />cllr <br />nr <br />rNEw( <br />d w Ne r <br />GFNfn1l CON1nAC DON <br />4A.1 ADIMESS <br />CI1Y <br />IIr <br />r,ll)NC STATE LICENSE• <br />MfC1UNIUL CONIMC+DR q•II RIORE55 O'Y TIP PNO•:E $+Ari IICEMSfF <br />MIIMBMG CONIPACIDO MAN ADIMESS Clry ZIP PNGIF STATE LICENSE <br />CONTRACT PwE a wVRM <br />HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br />DFSCRIBF YK)RM AND S+ADE IN"OIL D <br />CONTACT MPSOY A. MIONF ND — <br />62LI vi <br />/a <br />I HEREBY CER7IFY 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 WIIL 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 1 COMPLY WITH THE STATE <br />-00 <br />CONTRACTORS LAW 18 27 RCW AND 296200 WAD. <br />9 Q <br />XI (y Q-�—• <br />S:GNA HATE <br />Pnorosko use or' PDPoINr. <br />;r Zg <br />LEGAL DEScmrDDe LT ntt,P,, NBT--OR A"ACH Two COMES) <br />L0I SIX.a_ <br />00�R--ODDS <br />> -1D <br />PAPCEl LAY MIMBk <br />CCNSIRIICTION IO•N IFNOFR. ESS. 1111-ONENUMBEn <br />CITY BUSINESS LICE W E NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE DF FIXTURE OR IILM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -A INDUS UNITS <br />BATHTUB <br />FORCED AIR 5/STEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWED <br />UNIT HEATERS <br />KITCHEN SINK d DISP <br />CLOTHES DRYERS <br />DISHWASHER <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 DRAM <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE - BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />+_ <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />___ <br />TOTAL FEE $ <br />rVN urrkE.0 oac vn1.I: <br />FPONT SFTDACM <br />PFAD SEIP M <br />SLOES ILACN <br />MANIC CMNUWFR- / <br />IEF���i <br />PFCFIWNO <br />use F <br />Tor APEA <br />I I Z <br />vcu�strE <br />DYE$ <br />FEES <br />VALUATION <br />FEE <br />PIAIMNC. <br />,Z ( 8 <br />HERINT I-NIr,TION <br />UM a OwllpNG <br />SIZE Of Inm <br />J Y, <br />--.— <br />movWNG <br />VF1;1•ANICAI <br />i <br />_ <br />OCIIMANCY <br />I NII M SIM'S <br />XCDPANI LOAD <br />B•44(4TE N+ <br />❑Y[S EMI) <br />Appll(WAI M1AN ANC <br />FINE SPPPIMIFR PEG'D <br />nFAPON <br />au•En <br />PIPE AUNM PLO <br />NN5kY <br />$I AIF 8III1 D.C. SI IPC•k• REF <br />rvnur.'NEIM$ <br />TYPE m ",' <br />�T <br />AL <br />Crt•ns•rrnovrn D• CITY OF EVERETT <br />LOCAL SALES <br />DATE O�Z; c% TAX CODE IS 0105 <br />-- — <br />TOTAL <br />--' <br />