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APPLICATI�1 FOR CONSTRUC�N PERMIT <br /> CITY OF EVERETT•9UILDING DIVISION � <br /> 3200 CEDAfl STREET•EVERETT,WA 98201 •259•0810 <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDING P4 MECHANICAL O PLUMBING ❑ SIGN <br /> PROJECTAODRESS: � �(/� �f � � <br /> /1�E�rY�HB 2-�r� /rV-`' SF �tJO ,�r�[.� 6'0 53 - O.'�J(o <br /> ���P /' YNLMI/IE55 pM1 ]IP- Vllpl( <br /> i/1ClL (G�t(!�-L2_ <br /> rENNl1 u4lNpn(ss cllr )�r v�qME <br /> YC1�l[LiMOE5qMl1 WVIMpIE55 CIfY )II• �IqME <br /> OFNEMICONIMC�pI 44lIUME55 L�Iv — J�I:-- p�ttlNf S��ILIKfNSE• <br /> YEMANIC.4Cp11ML�M u4l�qM1E55 f11Y pi• p�'°y[ SGIELKENSE� <br /> 1��.,I CO iiPG✓ C'o � t�o �axss3 rrl�T/c../��oy�/7�G1G6 P� AYi/ySN4 <br /> VlU1RWGCONIPI�ip1 M4LAU111E55 � CIIY� 7—�— ] <br /> 1�� '��� SIqEl�FNSE� <br /> C tMCfpp�EOiMOnx —� <br /> M <br /> _��SD f1EATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> oEscroee naw�uq sown[roouo¢r�vav[o crvnrc�r[�isa�ua�r�roxr rro <br /> yd�tc s,�J�iJ r L,«va-r �v�r�.uv FrIR ✓G LO/SGtI J ,7G6 %JG Gr66 <br /> Gvo ,— <br /> �� I HEAEOY CEHTIFY THAT I HAVE READ AND E%�MINED THIS <br /> rnaaouousE a eutpxa APPLICA7ION AND NNOW TNE SnME 70 BE TRUE I1N0 CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLIED WITH WH�THER SPECIFIEO HEREIN OR <br /> IEG�IOE%qIP�pNpfAq1'(IIIY�9qM1BElOwpl��lAG111NOCp'IE51 NOT. iHE OAANTIN6 OF A PERMIT DpES NOT PRESUME TO GIVE <br /> ior eiocx or AUTIIORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER S�ATE Ofl LOCAL L�W qEGUUTINO CONSTHUCTION OR THE <br /> PERFOAMnNCE OF CONSTRUCTION.THl1T I AM AUTHORIZED BV THE <br /> OWNER OF iH15 PROPEHTY TO PERFORM THE WORK fOR WHICH <br /> APPIICAT�ON IS MAUE AND � COMPLY WITH THE STATE <br /> wu�cEliwtlo.wuxq WNTRACTOBSLAWI6 RCWAN0296200WAC. <br /> wxsmwnwiawiEuu�n.�wnEss.�Eicwa�v[riwotn x_,1�t ' TALO`— z>�iJ7 <br /> swxn� n o E <br /> cirv nus��ss iccNsc r+o <br /> PLUMBINO MECIIANICAL <br /> NO. TYFE OF FlXTUflE OP IiEM FEE NO, 7YPE OF EOUIPME R FEE <br /> WATERCLOSET�TOILET) � q�—MiNOLOUNITS ..3 /J —r— <br /> BATHNB FOfICEU AIR SYSTEMS <br /> UVATOqY(WASH B�SIN) I{E�T PUMP <br /> SHOWER UNIf IIEATERS <br /> NITCHEN SINK 8 OISP CLOTkIES�RYERS <br /> DISH WASHER MNGE fi00D <br /> UUNORY TRAY WATEfi IIEATEFi <br /> CIOTHES WASHER WOOO STOVE —�— <br /> URINRL MEfAL FIf1EFLACE p400D 6URNING) <br /> ORINKING FOUNTAIN FIIIEPIACE INSERT�VOOD BUflNING) <br /> FLOOR URAIN G�5 RRGPLACE <br /> BACNFLOWPREVENTERS ' GASNWGE <br /> _ SIKK�SERVICE—9AR,ETC.) �— cns rma.o <br /> D(I IAUSi FAN <br /> _— �_ <br /> SUBTOTAL f SUBTOTAL f <br /> PERMIT S PERMIT f / <br /> TOTALFEE f TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> [PONTSEIPACN ns�nsFte.�cM sio[sc�e�cn n��iu¢cxmiunm� rcr nEctmrrro <br /> � S <br /> usEior�E mtenEs vecuayl[ FE S V�LUAiION FEE <br /> ❑rts ❑rro omunr�r. <br /> HEI611I11Y11�fION NOOipW[lUMO $IfEOr8lDY11 <br /> UNII$ <br /> ru�unwn <br /> OCCU�ulCY IqrySIM{5 OCCUP�N�IO�D B�SEMENI —�— <br /> ONOIR 4ff,11.Wlf,�l <br /> ❑vE5 ❑NO <br /> {pEFi1�N1MLFOflEOD �F�Sp! �OUIIfINqA�NLI11f.M <br /> �__ <br /> omrn <br /> rn[u.NMr+co�o nE.sw <br /> RI�IE III�I INM SIH1f.11�iq[ <br /> rvveorr.ous� mnr�s�nnpvrnor CITYOFEVERETT nmur.vrtxuv <br /> LOCAL S11LES - - <br /> u��E TAX CODE IS J105 Tot�� <br />