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APPLICATION FOR CONSTRUCIfON PERMIT <br />CITY OF EVERETT • BUILDINC DIVISION <br />02DO CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL Cl PLUMBING ❑ SIGN <br />PROJECT ADDRESS: /( & -Z.1'� ST. S.h- pl),+j& <br />IFNWT <br />all <br />» <br />- <br />n101A <br />APCNTFCI on aT101NA <br />YM A00Rb3 <br />Mry <br />» <br />Apq <br />ww"AL ONIW — <br />YYl.lpbq AS <br />OM1 <br />» <br />PAM {MTFISFNYI <br />Y[CNbYCAICdIgIEIGR <br />YAAAWAISS <br />CITY <br />» <br />PI %TATF II(fwI <br />PIIIIAINACWTAA[Ipl <br />YY, AIQKR Se <br />G1Y..,, <br />» <br />RRAq STATE ICENSEI <br />HEATING SYSTEM: ❑ OAS ❑ ELECTRIC ❑ <br />OESOeSE gdSi AMe eOWR IpJ1Aa PNaATP <br />COIIIACI Rg10N AMI PNOAF W <br />1Ze <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 AIID 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 />AUllIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRICTION OR THE <br />PERFORMANCE OF CONSTRUCTIOI. THAT 1 AM AUTHJIIUEO BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW IS 27 RCW AND 2" 200 WAC <br />% <br />ProroEFOux a elAlaa <br />U!" WlCRPIIpN a PTIOERTTIMYJI KLMM AHACN IIq sj <br />LOT NAOI a <br />PAllfst tµ to TAAEq <br />�S9yj nn1 nm <br />EOMIIIIICIeYIIGµ IINaR APpIIFµ RIEIIIbE MAlEq <br />�"'AM'E wIE <br />b1Y ETIlEµ lE[IIS[ Nq <br />PLDIMUG <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EOUV~ <br />FEE <br />WATER CLOSET (TORE <br />AMC—MSIOLO UNITS <br />I <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />T <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />1 <br />SHOWER <br />LTFAT HEATERS <br />KITCHEN SINK A DISP <br />DISHWASHER <br />I <br />I <br />AOT/IES DRYERS <br />RANGEHOOO <br />' <br />LAUNDRY TRAY <br />I <br />WATER THEATER <br />1 <br />CLOTHES WASHER <br />I <br />WOODSTOVE <br />URINAL <br />I <br />METAL FIREPLACE (WOOD BURNIN0) <br />I <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />I <br />I <br />FIREPLACE INSERT MOOD BURNING) <br />OAS FIREPLACE <br />I <br />BACKROW PIIEVENTFRS <br />4--OAS <br />RANGE <br />1 <br />6VEK (SERVICE —BAR, ETC.) <br />I <br />GAS PIPING <br />' <br />EXHAUST FAN <br />I <br />� <br />I <br />� <br />BI1B TOTAL S <br />' <br />SUB TOTAL. S <br />PERMIT S <br />PERMIT S <br />I <br />TOTAL FEE S <br />TOTALFEE 81 <br />I <br />FOR OFFICE USE ONLY: <br />FR TSFTSAOt <br />WAR QI{ACe <br />FOE SETBACK <br />/IANO(LA MIMER <br />FEF <br />waPlw <br />m HKt <br />_ <br />IOI APFA <br />V. l Yq <br />[TITS G M <br />FEES <br />VALUATION <br />FEE <br />FA PP n <br />1EgN1lYTA1pN <br />Ala /WF1111O <br />Ylfaq[MI <br />INIAAS"ol <br />C�NCY Np pII1MF <br />F1WI <br />¢CyYNIIWD <br />9.ww <br />❑II! ONe <br />Weft <br />IPIES 111 gFY9 <br />Af ASRN <br />1{e1110N4 TSAN ulfT <br />AHEM <br />FR AIMYIEO'e <br />NA{oN <br />SIA1F SIIKPNfI HAICNAAgE <br />IYPF af.OMSI <br />PIAIISAMgY(Per <br />wle <br />CRY OF E4ERM <br />LOCAL SALES <br />TA% CODE IS 3105 <br />nAS S:gMAS <br />TOTAL <br />