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APPLICATIOR FOR CONSTRUCT& PERMIT <br />CITY OF FVLRETT A BUILDING DIVISION <br />3200 CEDAR ST9EET A EVERETT, WA 98201 A (425) 257-8810 <br />fJ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />PROJECT ADDRESS: 3`I 82�RSw __ Y75-1.•11-2'i 1 <br />y-AS-4l9-zz9 <br />g£ la IvlgJtc %u1�y �Itf 69U7 COlA, C.RIFr r $ E-¢/� illr+r c.K-7.-ralm. -48oSY <br />o n aNIAIXIA1f!! On %ION[ <br />IINANI 4M Mg1R!! fln !w %N!R <br />PIILl111Ct OP nfYdRP MN MYTf SS C."F. f•N}lf <br />5 ii 1Mr G _ <br />MMn4CONlnKlm UKAVOPESS VI• lV' ngYl SMII IXrw. <br />WCNAWAL CONIPKT0 aASAWMSS On to M1IPW PLAIf IKrNMA <br />%1P16%000NIPKIOR MW ANMF S! Pn H rqy FTATF MAW <br />car llflCEpANI11R <br />/ '/�'L- <br />� <br />HEATING SYSTEM: ❑OAS ❑ELECTRIC ❑ <br />MICw/F WJIIR ANU lQ1APF IOJIAOE %V0.VF0 <br />LI VI/'IS <br />CONiKI %RSON 1URI1'1N'YIA NO <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION ANP'INOW TNF. 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 OWE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED Pw THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORSLAW 16 77 RC AND 296 200 WAC20 <br />A. f-i.✓V jam- olt <br />IYIaollPulE orw wArP <br />S <br />IFoa axwPlXSM nAOMRn IYOM1 M.OW .nKNlwo caxsl <br />lol elocR _._ a 1 ? —9 -7 <br />_ <br />pF A. TY•wl • F <br />PaRlsalT- 39L9-o6z- 00 —ooe <br />PMICrI MA m MAwrn <br />fX1NlIwKI10HlWMIrN1FP M1YlFSl. RIF%ID.IMANIFR <br />SYW.nm OA1F <br />OL•!1!!IL[S1lNTNSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OP FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EOUIPMEMT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C—MfNDLG UNITS _ <br />2. <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 6 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINXING FOUNTAIN <br />I <br />FIREPLACE INSERT WOOD BURNING) <br />FLOOR DRAIN <br />I <br />OAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />' <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUB IOTAL <br />S <br />_ SUBTOTAL S <br />PERIYT <br />s <br />_ PERMIT E <br />_ <br />TOTA.FEE <br />B <br />TOTALFEE E <br />CON OFFICE LIRE ONLY! . i/.1: O(o <br />I%1NI ViPAI'P <br />2n <br />KWNIW:R <br />'Zo <br />IMq x1lACP <br />J <br />M1ANCLIfq MI1NP <br />Off ( <br />Merv, NO <br />IrM IMF <br />IOIAMA <br />VACANT YR <br />FEES <br />VALUATMiN <br />FE <br />IIFNWIIMwNIN <br />wmPARIM <br />unwitudll <br />n11NIM1co <br />�ORJL1OIySR_P�91M1. w�nSuwU <br />Inx sir yIIlx Mat _. <br />IIfL1ANIlOA0 <br />IAAWNI <br />Dr!! NO <br />WfN.Mf4 <br />GO <br />-- <br />ArS%R n W cMbl <br />KA1 <br />'-- <br />MAIM <br />OIWn <br />fvEN rtroo <br />MAIM <br />SIAII 61%ONI SIIRCMACW <br />— <br />rn <br />'v <br />leer nl CONl1 <br />nANR A%amrnn• <br />rMit <br />CRY OFEVERETT <br />LOCAL SALES <br />TAX CODE I8 3103 <br />mar..=g. <br />-- — <br />TOTAL <br />-- <br />-� <br />9 (p <br />