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APPLICATIO. FOR CONSTIRUCTt - N PERMIT <br />CITV OF EVERETT • BUILDING DIVISION �/ <br />3200 CEDAR STREET • EVEREiT, WA 98201 • 259•8810 <br />❑ O�MOLITION ❑ COM�Br�INpAT,ION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />P� �J�TAD�RESS:c��UC� I� • r� GT � tJE�ETi ��,Zpj�I <br />ownei��J�l E�.� � z��CLE'�cJ�rC'�'�9 %%-� C._1��"'C�7 S C.�]o j� FI��n.Oivl� S— _ <br />IEN�Nf 4�5 GIY jiP p�pqE �.//�'� /'L�b�oC O <br />��--- __ <br />OII OESIf1H[q 4MI MDf1E55 f.IIY !n' P�qNF � <br />�L C.—=�c li.rr����� J�'�K�r�.v .�y r.�a. 9�'�a? <br />;x,mecirn wuiwnnrss cnr � Im rnopc Sf�1E110EN5E� <br />MECN�VItp�CONTR�tTpl MMl�Op1E55 CIfV 71P F110N[ Sf�Tf110EN5E1 <br />��� <br />MUMEW6Cp11R�CTp1 M�I1�0011E55 p1Y 71n P1qNE ST�fELILFNSE� <br />s <br />ior <br />•NO Sq1�RE <br />ei oc� <br />�?.�S <br />PMCEI TNI I.D. M1MBF�1 �I <br />�?��a11 v`-a o0 7 poc <br />CONSTi111LTION LON/ lENOEq, �pp11E55. TElE1'110NE NU4BER <br />TYPE OF flXTURI <br />WATEN CLOSET (TOILEn <br />BATHTUB <br />UVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />UUNDNY TPAV <br />CIOTHES WASHER <br />UFINAL <br />DRINNINO FOUNTAIN <br />FLOOR ORAIN <br />B4CKFLOW PREVENTERS <br />SINK (SERVICE — OAR, E7 <br />FOR OFFICE USE ONLY: <br />iPONT YtB�CM RF�115FIB�CM <br />USE IONE <br />11E16NT 11u1T�T10N <br />6MXIP�NCY MO d 5 <br />fIOE SPNINMIER REO'0 <br />iIRE AURM REO'0 <br />tYPE M f.ON51 <br />l01 MIEl1 <br />HEA7ING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />f.ONdGf FC�SON I1H0 PIIONE ND <br />I HEHEBY CERTIFY THAT I HAVE READ AND F.XAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE ANp CORREC' tLL <br />� L r PROVISIONS OF LAWS AND ORDINANCES OOVERNIi1G THIS TYPE OF <br />WORK WILI BE COMPLIED WITH WHETHEFl SPECIFlED HEREIN OR <br />ic�esi NOT. THE ORANTINO OF A FERMIT DOES NOT PHESUME TO OIVE <br />_ AUTHORITV TO VIOLATE OR CANCEL THE PqOVIS10N OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINO CONSTHUCTION OR TNE <br />PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />AAPLICATION IS MADE AND I COMPLY WITH TNE STATE <br />CONTRACTORS LAW 1827 RC�+ ND 2 OO WAC. <br />x < �. , ���� ' %� %� <br />_ SKIH� U11E � D IE <br />SUB TOTAL f <br />PERMIT f <br />TOTAL FEE f <br />� SIOE SETB�CIt <br />NO Of DWELIIMG <br />UMfS <br />e�r — <br />IO�D <br />FEE <br />I ❑YES ❑ NO <br />51lE Of B100/11 <br />❑VFS ❑ HO <br />CITV OF EVERETT <br />LOCALSALES <br />TAX CODE IS J105 <br />CITY BU9NESS I ICFNSC NO <br />TYPE OF <br />A/C — NFiNDLO UNfTS <br />FORCED AIR SVSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES ORVERS <br />HF�NGE HOOD <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />1q�NC11ECNNUM11f11 fFf <br />� ��� � <br />FEES <br />OItlIOW(i <br />PIIIMpINf. <br />4fUUNlf.I1 <br />�pp1110N11 PI�NC��lGX <br />Ot1�Fn <br />SI�iF OUIlDIN6 51111QI�MiE <br />Pllfl� IC YIOOnS <br />TOTAL <br />�EE <br />—r— <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />11Ff.F1P1 HO <br />� <br />�v <br />r <br />!-_`"'-- <br />