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APPLICATIA FOR CONSTRUCTSN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA Wr011 • 259-8870 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: _2a o3 /t T/N A✓E' SF f_dreE?Te <br />Lf/LL 6iSHaP S�,?S E/W',QTS,Po S</�9s `nP[ 45��� 7,1,7 <br />OMIIfR YMl KOR55 C'1Y ZIP RIDNE <br />/�dELf..c' f�.✓c S/c yr N�AO/1 'ss <br />TENANT YAK ADp1E55 an !u vrgNE <br />UCN1Ecl OR DESIGNER .1P NEss an nP PNDNF <br />m <br />..I <br />aNrPwcr PUEICE a,N _ <br />CZ, <br />S b w <br />hEATING SYSTEM: GAS ❑ ELECTRIC ❑ __ <br />WJRM /r.Np SOVPRE iDOT/LE W VgVEO <br />- ) A N ?e o0o t <br />Cd11ALl PERSdI NID PMDRE Ip <br />4L�.J THiEtSE/✓ 303 G91/ X/3L3 <br />C NJ /oo _ an <br />I HE Ell- CERTIFY THAT I HAVL READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVIS:ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREON 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 />APPLIC TION IS MADE AND I COMPLY WITH THE STATE <br />CONTFI TORS LAW T RCW D 296.200 WAD. <br />vrprossDUSEa ButdNa <br />LEGALME PTION GE PTgPERTY ISNdNN BELON MARACN TWV CMESI <br />L07 BIQK a___ <br />PAAIDEL W I ��/ <br />c YTRILTMXI LWN LENOEA, AGGRESS. TELEPNdIE"ITER <br />SpNArUAE V WTE <br />OTY BUSINESS IKFNSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOIRPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —AAINDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />' <br />LAVATMiY (WASH BASIN) <br />HEAT PUMP <br />�— <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A 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 DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREIJENTERS <br />GAS RANGE <br />y_ <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />.y <br />EXHAUST FAN <br />SUBTOTAL S <br />SUB TOTAL f <br />PERMIT sl <br />PERMIT f <br />TOTAL FEE f <br />I <br />I <br />I TOTAL FEE f <br />O B <br />FOR OFFICE USE ONLY: <br />FTIdII SEMAU <br />PEAR EEid1CR <br />YDE SFIIACA <br />PLAN PKQ NVLE[R <br />SSa � <br />FEE <br />RFCEIPr NO <br />USE ZDNE <br />LOTAREA <br />vAu,Nr SITE <br />FEES <br />VALUATION <br />FEE <br />Butdw <br />OYES ONO <br />KE NT UUTATION <br />w v E WELUNO <br />UNITS <br />SIZE OF ftw I <br />PLu1AEw <br />I <br />CCwPANLr <br />c Dw <br />Ip dsrEMLFs <br />accwANI LOAD <br />IAYI,(Nr <br />MECII.CAL <br />❑.Es ❑ Nn <br />AWNf)hkLIl"CNf CN <br />�� <br />— <br />FIAESMUNKLFRREOD <br />AFASON <br />DINER <br />FIRER Nl AEGD <br />RFAION <br />STALE IN. E INC. BINKNAIME <br />TYPE O CONsT <br />MANS AP EO By <br />bi <br />DA I - 9 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE 15 3105 <br />MKRK waPKS <br />TOTAL <br />