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APPLICATICA FOR CONSTRUCTON PERMIT <br />CITY OF EVERETT v BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 •2S9-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING VQ MECHANICAL RD PLUMBING ❑ SIGN <br />PROJECTADDRESS; %/ `% �% �/d! .,� <br />O'MIER YMIAWRES$ CITY SIP Pry c <br />-/YDy t4C Gr r_Y,ml( IG 15711 - 123" AU¢ Sr s,001joINIsa 9F 140 3(co sER 310w <br />TE 4 NANT NL Lb FSS CITY "i, ' nq„F <br />41CNRCT m UEy ER "I AUMESS CITY )III PNWE <br />ti L1 w1LC G.hQYMIaX ?An KC <br />GENERAL CCNTMCTCR 4.ULMCTIEss CITY )IP Mgxe SIMI ICEW. <br />L It3.Cn.:T Nrtn r�..F 14o4l_"oµ5L SE TSJcn —_ zs-r-nAl.c <br />erL:;.yIC R.l <br />44L AWRESS CITY III, `,I E <br />CONTRMTVRCEarrnR 9,z S% / <br />HEATING SYSTEM: ®GAS ❑ELECTRIC 0 <br />WEE YIOIYt AFAID 0WT1E FOOTME EWCLVEC <br />'I -L r-A ❑i n r T-fl, )r- lot <br />CMTACT PERSON ANp pHCIN W /_ 1 <br />,C// <br />S —T <br />I HEREBY CERTIFY 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 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 CONSTRVCTION,]�HAT I AM AUTHORIZED BY THE <br />OWNERpF-THIS PROPERTY TO PERFLZRPA FOP WHICH <br />APPLICATION IS MADE AN I COMP / TH THE STATE <br />CONTRACTORS(.A .21RC ANd4B82 WA <br />X �/\/ ( VF1.Y/' <br />A T L DATE <br />Pro D USE CFBM w <br />IEOAL Ms "ICN OF RCP W tSHCvm IIELOVY M Art CHT COMES) <br />LOT �_ lACrx __ or <br />Sj/p,2 l7L A T Q l - "T L, <br />PARCELIMLO M R <br />C061p1LiCN l6W IENCER. ACCRESS.IEI(vTCNE Nu4ITER <br />4),.i 1-I T'17 r TiJ� L I) IS, t M T. UFEnul <br />(3(,O 33 L, - 3171 <br />CITYWVNESSLCENMW <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />17 <br />WATER CLOSET (TOILET) L <br />A/C —AAiNDLG UNITS <br />BATHTUB <br />1 <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT?UMP <br />�— <br />SHOWER - <br />UNITHEATERS <br />_ I <br />KITCHEN SINK It DISP <br />j <br />CLOTHES DRYERS <br />( <br />DISHWAS.tER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />I <br />CLOTHES WASHER <br />WOOD STOVE <br />--� <br />_ _ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVF.NTERS <br />GAS RANGE <br />SINK (F•RVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN j/1 <br />SUBTOTAL f <br />SUBTOTAL f <br />' <br />PERMIT f <br />12PERMIT <br />f <br />i -: I I <br />TOTAL FEE f <br />TOTAL FEE S <br />�' <br />FOR OFFICE USE ONLY: -Y4.G Z-i- r /' n.I)4 I44.',1V i <br />,R TSEIRACR <br />o <br />KARSFTBACN <br />zQ' <br />SICESETBAC', <br />5r <br />PlA11 CNECR ww"" <br />6.Ila.,'i <br />rEF <br />RECFWI TIC, <br />uS zCNE <br />2- I <br />LOTAREA <br />�Zs <br />vnC., SITE <br />D NO <br />FEES <br />VALUATION <br />FEE <br />LTtmw. <br />HEIGHT uMTATION <br />z s <br />NO Ci IAYELuw <br />UNIts <br />I <br />SIIE OF BILYYI I <br />/57o sF <br />PIIIWLWG <br />V:ANCY <br />123,) F <br />CIF IIOWES <br />I <br />OCCUPANT LOM <br />W,,t <br />❑YEs )kNO <br />uFCIIAMCAI <br />AMFI WL MANCIIFCN <br />- <br />REO'0 <br />REAS <br />CITIES <br />FEIEALAFWREC'C <br />REASON <br />' <br />STATE EOtL .STDCIWI,E <br />IS%I <br />TYPE aca+st <br />_l'N <br />w+ISAPPROVEG Er CRY OF EVERE7T <br />LOCAL SALES <br />OAtE Z� yi3 TAX CODE IS 3105 <br />MITI, W..wO <br />J Q <br />��— <br />70•AL <br />