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APPLICATIOlt FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 99201 • (425) 257-8810 <br />❑ DEMOLRION ❑ COMBINATION ❑ BUILDING ❑ MECHANIC#!1. PLUMBING ❑ SIGN <br />PROJECT ADDRESS: /O/% 3(1' J7UI <br />/ \ <br />Y7 <br />APCI.TTCI OR MF LINER <br />MAN AOONEss <br />cry <br />nr <br />vNOHF <br />OFN[RAI CONt0ACIOr <br />W1 <br />MAIL ADF5s <br />CIIY <br />!ir <br />MNIYE <br />SIATf tICFNSf• <br />MFCNAMCAL CWnAC'OR <br />MAILAWNF55 <br />cm <br />tm <br />rN,,r <br />IIATF LICENSE <br />MIIMBINfi CONIRAC1pR <br />MAIL ADOPESS <br />CM <br />!ir <br />"I <br />SLAW IICEIdE6 <br />CONIFIACrnMCE Or wol. <br />HEATINGSYSTEM: ❑GAS DIELECTRIC <br />OSCcZ:AARE 00 IWF NwVO <br />CONTACT MR5pAM nNpNO <br />/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />&/q <br />LG C d •�-� <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />PPOPOSFO USE OF PUNoING <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />EFGAI.OFSCRIPtION OF PROMRTY MANZI Ktm Art HTwo CORES <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV151ON OF ANY <br />lOT BlOcx Or <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />r Euic ltul!o M17P <br />-6,` 7 <br />CONSTRUCTION LOAN( FNMR. 4OOPESS. 7I1Ir ONENIMIEP <br />x <br />OW <br />s <br />GTY M9NESi LICENSE NO _ <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />UR <br />NO. TYPE OF EOUIPAIm FEE <br />WATER CLOSET (TOILET) <br />WC—M*M)LG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK A DISP <br />CLOTHEC DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />W DOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />INSERT (WOOD BURNING) <br />DRINKING FOUNTAINFIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PRF.VENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMR S <br />PERMIT f <br />TOTALFEE S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FA NI UTPACK <br />Pr AP SFTPACK SIM SFoWK <br />n1AN CIIEC. NUMF(N/ rFF <br />PFCRrr No <br />IrsE zcAr <br />Im ARFA YCANt SOL <br />FEES VALUATION <br />- FEE <br />PIAIpw <br />p YES ❑ w <br />IlElolo IIWA11OY <br />NO Or OAFL.IA3 <br />IIHIIV <br />SIZE W BLOGRI <br />M114PING <br />4Fl:.ANW..t <br />OCCunAI.r.Y <br />MI fN 51fA'f5 <br />IX:CIIrANI IOAII <br />PASFMfN1 <br />cnour <br />❑YFS ONO <br />— <br />4WIIIO4A1 nl A4 CIIfC. <br />rIPC 5M11NLlLR P[0'O <br />MASON <br />OINFR <br />fINE AIAPM PCO'O <br />PFASOv <br />$pll flIFlD.rtiSMCNA�[ <br />nrF On:or6T <br />MAYS AI`PPOVfDPY <br />CRY OF EVER <br />raflur. wogs <br />_ <br />LOCAL SALES <br />-- <br />TAX CODE IS 7105 <br />TOTAL <br />a.tE <br />