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APPLICATI�N FOR CONSTRUC*AN PERMIT <br /> CITY OF EVERETT•BUILDING DIVISION � <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •2�57-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> PROJECT ADDRESS <br /> owv� / usReppnEss _ Gi,� PtlONE , l, � <br /> ��P $�,Q„Cq izo34 /y,0.r s,�_ ��P�l�f ��lOfi y�5 3�'S z/s3 <br /> TENb1i F1AIl�D�FE55 ��17 I�P PMONE <br /> ARCNRCCiCPO[SK�YEf1 1AAILADMiEiS LIiY Dp PNOtl[ <br /> GENCIIeLCONiR/.GiOF MAIL�WFCSS LiiY 1�.? V��ONE SiI.iELiCENSE� <br /> �;ClIA!IICALCON n+c�)f*p� �MAILA����� � ��l� ���� 11P PII'JNE Sl�iEIICEII$E� <br /> �����/ �/��� ~ //1 � ��s� y�»�3�yc2 ,!�i9�ia0'�9drA/�Z <br /> fLU1.l0iI1GCCNiPAL10R YA:L�DOBE55 CIfT I'% PNpNE STAiEIICENSE� <br /> coranncr vaiceov wo�L�� NeATING SYSTEM: (�i GAS ❑ELECTRIC ❑ <br /> DESCPI6Ew RN �D JNiEF OiPGEVN0.VED CONULLPER ANDPN �EI . <br /> "r .Fur.,r,c r r—/} -C t.9`. <br /> z " q (��/LZ <br /> . I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AIJD KNOW THE SAIdE TO BE TRUE AND CORHECT ALL <br /> FROPOSEOIISEOFBUIL��AO PROVISIONS OF LAWSAfID OROINANCES GOVERNING THIS T/PE OF <br /> WORK WILL 6E COMPLIED WITH WHETHER SPEQFIED HENEIN OR <br /> LEG0.0ESCPIPiIONOFPROFEfliY�SHOWNBEtOWOMTTAC111WOCWIES� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or o�xK or AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHF.R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOpMANCE OF CONSTRUCTION.TMAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PflOPERTY TO PERFORM THE WORK FOR WHI;,M <br /> APPUCATION IS IdA.^.F pN� I COMPLY WITH THE STfTE <br /> Pu+ce�ux i o.r�uuoea GONTfl LAW 1027 RC/W AND 29F200 WAC. <br /> CONSiPUCi100LOANlENDEP,ApDf1E55.1ClEGHONEINMBER x ✓" G'(/ '-"+ �`C �� <br /> SIOIU OE �� 9 ORE <br /> / <br /> C�iY BUSmG55 LICEN56 N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUPE Oft ITEN FEE IIO. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILET) NC—NHNDLG UNITS <br /> BATHTUB FOflGEO AIR SYSTEIAS <br /> LAVATORY(WASM BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCMEN SINK 8 DISP CLOTNES DRVERS <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ! WATERMEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD PURNING) <br /> �HINKING FOUNTAIN FIREPLACE INSERT(WOOD BUflNING) <br /> FLOOR DHAIN-- GAS FIREPLAGE <br /> BACKFLOIVPRFVENTEPS GASRANGE <br /> SINK�SERVILE—DAR.ETC.) GAS PIPING <br /> E%HAUSTFAN <br /> i <br /> SUBTOTAL S SUBTOTAL S I <br /> PERh71T S PERMIT S <br /> TOTALFEE 5 TOTALFEE n <br /> FOR OFPICE USE ONLY: O(j - �� <br /> il101RSEipALN PEAflSEIU�IX SIOE`.[iBACft PVNCIIECMNUMOEB iEE RECEIpTNO. <br /> usezaie �oreaee vncnvrSrtE FEES VALUATION FEE <br /> ❑YES ONO BNIpNG �— <br /> HEIGNiLIuliAiqN NOOFDNRIVq SQ[OFBLDG41 —'--t — <br /> UWiS PW40RiG I <br /> OCLpPeNLY YO W SIOFiES OCLUPdfli LO�� BASEMENT IIECNANiC0. I —� <br /> GROUP <br /> ❑YES ❑110 — <br /> FIPESPflINNLEflPEOD REAAN �ORION0.PWICNECN <br /> O�HEB I <br /> FiqEALAfIMBEO➢ RFASON I <br /> 9AiE�Ui�OWG Sl1uC1�MGE I <br /> I <br /> irPea�to�rs*. rwsnvcawener CITYOFEVEflETT aueiww0aK5 <br /> LOCALSALES <br /> oerc TAX CODE IS 3105 TOTAL <br /> J <br />