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APPLICATIOAFOR CONSTRUCTIft PERMIT <br />CITY OF EVERM • BUILDING DIVISION <br />3200 CEDAR STREET • F.VERETT. INA 98201 •259-BB10 <br />❑ DEMOLITION ❑ COMBINATION fiD BUILDING fd MECHANICAL X) PLUMBING ❑ SIGN <br />PROJECT ADDRESS: / o 7 r 7 7 " All If Sr <br />TENNIT YNLM SS CITY <br />A TECT OR DESIGNER <br />.1 AWRESS <br />CITY <br />tI^ <br />PrgNE <br /><lwvYl It <br />G .y2 N <br />GENERUM. CCNTMCICN <br />YYL I.WRESS <br />__ <br />CRY <br />ZIP <br />WICY,E <br />SWE LICF-SE <br />ov-s,o,,jagit I <br />III) L. Ido4-roa'1rr, <br />sw r2v►•"-rr <br />Orr [.cr <br />MECHANICALCONTRACIOLL <br />YYL ADDf1E55 <br />5)( <br />C <br />,a84 �I(Y�rlJIL1.fG a <br />ZP <br />FIIONE <br />SIAIEIKENSEF <br />TA DILpBFJOAAJr <br />t7LJ ,5R <br />Fff . )nA=1g <br />PIUYBWG CONTF1K10R <br />YAILA S- <br />CIfY <br />tIv <br />rIgNF <br />STATE IILENSEE <br />CONIT4LT PPoLE OE wO1Vt " <br />HEATING SYSTEM: IV GAS ❑ELECTRIC O <br />pESCgEE NCgR EW SOUME FWTME WVQVEO <br />CDx1AGi rERSW A4p YII(X,E NO <br />ems./ <br />r Q.B.SIDRnJGAE <br />SIAiTDLFE rAN4w I 4 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND VNOW THE SAME TU BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES 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 RY THE <br />OWNER HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC TIO. IS MADE yE I CO M WITH THE STATE <br />CONTR ( S 027 AND 29 .200 AC. <br />vROrosEo usE aBUBIHNO I <br />IEGAL DESLFBPTIW Of THAOPERTY ISIIO'wx BELO'N CR ArtY:H nvo COPIES) <br />L07�eLUGt -� a <br />ELTAXID. <br />71 'L <br />MAIBfR <br />;)a / <br />Cd6TRUC110111OYI IExOER. /DEYIESS. tElEP110HE NUMBER <br />0 3 - I i 1 <br />, -,q sIGNAI Q DATE, <br />PO $DX h3 <br />PLUMBING <br />clry BuvxEss LlcfNSE ra <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPEOFEOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C -AMNDLG UNITS <br />BATHTUB <br />LAVATORY (WASH BASIN) / % <br />FORCED AIR SYSTEMS - <br />HEAT PUMP <br />�- <br />SHOWER / <br />KITCHEN SINK A DISP <br />UNIT HEATERS <br />CLOTHES DRYERS- <br />DISHWASHER <br />I <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />URINAL <br />--� <br />WOOD STOVE <br />METAL FIREPI-ACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACNFLOW PREVENTERS <br />GAS RANGE <br />--� <br />SINK (SERVICE - BAR, ETC.) <br />GAS PIPING _ <br />-- <br />- <br />EXHAUST FAN <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTALFEE S <br />TOTA FEE S <br />vlCE USE ONLY. / <br />FOR a•rrl...........�...... <br />FRONT SETBK <br />Zo <br />SETBKK <br />Z.a <br />SIDE SETBxCR <br />PII.N CIIECM NUM7ER I.i— <br />�7 <br />FE� /l /� <br />REfi tN0 <br />USE LORE <br />RE+ [L <br />TLO <br />Or;Y:G q' <br />VACANT WE <br />I.r<s ❑uo <br />FEES <br />VALUATION <br />FEE <br />nTxLnwr.E1%c) <br />Gljl_ <br />NE:GLrt uwunON <br />Z� <br />LNO I�owfwNF: <br />sln ar BLIJG'll <br />Y7j SDY S.F <br />OWWI-- - <br />77 <br />QCCUPM<Y MfY 51MI5 <br />ORWP n <br />R3 U-r L• <br />OLLWARI IOLO <br />BASEw:NI <br />❑Yf5 J�NO <br />Yf C11AMICAI <br />Aon110NAI nAN nIIc1I ' <br />4 <br />EIFE SPruRHLfR xO'o <br />REAsov <br />OUTER <br />WREA AEG <br />REASON <br />SIAI[ BUILfHNC. SIIRCIIARGf <br />T^il/�/ <br />Puwlr. IP' <br />,,EE CT roust <br />`�-� <br />`CT_/`( <br />PtANSA PROVED <br />DATE 1 159 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAXCODE IS 310S <br />TOTAL <br />