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APPLICAAN FOR CONSTRUAION PERMIT <br /> CITY OF EVERETT A BUILDING DIVISION <br /> 3200 CEDAR STREET K EVERETT,WA 80201 •257.8810 <br /> I I DEMOLITION ❑ COMBINATION ❑ BUILDING 4 MECHANICAL O PLUMBING ❑ SIGN <br /> PROJECT ADDRESSADDRE <br /> ( '.n, r '6FAr/ u le (o 3tS e tPEyere !y/1 4'8ao3 <br /> nRART NALADDTESS MY IF <br /> N TECTOROESOWA "LLADDWAS Clry 7P P"CHE <br /> �, . v n! nEaU /tY %4irn • � Af; •n ICERSE <br /> l p+p <br /> IAEC1AWMCPITR• 1011 uu•DDRE511 _. COY IF FN}'A STATE LIODWA <br /> r25 e-9W/ <br /> FLWBMG CCNTRACTOR WIADDMSS an IF "'CRE STATE LDERSEF <br /> CONTryc TACE OF WMy- <br /> T <br /> &%".) HEATING SYSTEM: CEffiAS ❑ELECTRIC ❑ <br /> DA AW ME i00TA0E BNRV[D CCM RBDR1 ND�1 <br /> yy ME <br /> 1 HEREBY CERTIFY THiT I HAVE READ AND EXAMINED THIS <br /> E�- APPLICATION AND KNOW TNF SAME TO BE TRUE AND CORRECT ALL <br /> RROFOO°H°f BUK0N0 ?1 PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TYPE OF <br /> WORN WILL BE COMPLIED WIT,I WHETHER SPECIFIED HEREIN OR <br /> LEGAL DESCRPTIOR OF FROPERrvTYOWW won OR ATTACK TWOLJER NOT THE GRANTING OF A PENMIT DOES NOT PRESUME TO ORE <br /> LOT FLOCK a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW AEOULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRIF:TION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY ID PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> TYPICAL TAF 10 AALRER CONTRACTORS LAW <br /> W1/18.27 RCW AND 296.200 WAC. )) <br /> COYSTITUCTOR LDAN LEADER,ADDRESS TELEMONE ALASKA X )&'/. /l 4-') � <br /> 40R•ADTE' DATE <br /> COY IKRWESb LCENSE NO <br /> PLUMBING I MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(Tr ILET) NC—lV NDLG UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK A DISP CLOTHES DRYERS <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT(WOOD BURNING) <br /> FLOOR DRAIN GAS FIREPLACE <br /> BACKFLOW PREVENTERS GAS RANGE <br /> SINK(SERVICE—BAR,ETC.) I GAS PIPING <br /> EXHAUST FAN <br /> _ SUBTOTAL S SUBTOTAL A <br /> PERMIT f PERMIT f <br /> TOTAL FEE A TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SE TRACK SIDE SETBACK MAR PECK MRMER FEE PACIFY NO <br /> USEt°RE LOTAREA VACART Sin FEES VALUATION FEE <br /> DYES DAD END <br /> REIDNT LYrtATKM ND OFDATUMO WEahOMI <br /> LKXAs MLTLTSBIG <br /> °CCIF.WCY NOPbTORLL OCCWMIT LOAD MSEYEMT YECR4R•Al <br /> ORPF OYES GN° <br /> FINE{MIMIER RLQ° MARDIADPTCEIL MLMI CHECK <br /> ONE" <br /> FMF AIARM RL°D RF•WN <br /> STAR MLDRNO SIOCTMAI E <br /> TYFEacorreT TUBS•IAROVFDo, CITYOFEVERETT IRMCWDRws <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 1 TOTAL <br />