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APPL.ICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT E BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257.8610 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />PROJECT ADDRESS: _Inirin EyLeazis-Fwl WAN <br />FA #Q4C �jr acS InYYE" EM6.CXQE1AN W-*11 el�sr 9SZOV- <br />IWNEP - I%MLA If.55- .11 LIP PRONE <br />AMHRECTORDE$GNEP MAIL ADDRESS CITY 11" PIRMF <br />GENENAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PRONE <br />SIAIELICORF- <br />liff-YE2 --4(.M <br />CO 1AK. <br />9Z61 <br />SCYhrte <br />4S/33 266 <br />410 Fht13 <br />MEYE-XX-*Z/9PG <br />MF.CHANICALCONIRACIOR <br />MAILADDRESS <br />to'/OX .53j 13 <br />GIY <br />ZIP <br />PRONE <br />STAIE LICENSE <br />M UMBMG COMPACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STAFF LICENSE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ca¢NOoWE <br />DESFWIAGE VIVOLVED <br />CORTAC1 PERSON AM PHONF NU <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 AHD 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 />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 BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW 296.200 WAC. <br />X - <br />PROPOSED UDE of BGBGNO <br />LEGAL OESCPIPTIOP OF PROPERTY FSHEMI BELOWdRAVACH PAID COPIESI <br />LOT BLOCK or <br />2g28— L _ <br />PALI TAX I D. NUMBER <br />LWSIPIIDIICN LOANLENDER. NUPESS. IELEPYRAE NUMBER <br />PLTTIT �MDRI�_CQ <br />B Al DATE <br />-c*BTTLE WA qR 164 %]IC I/ <br />(TSeln <br />G1Y BU5FESS lILEN5C N0 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPEOF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 OISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT S <br />_ <br />TOTALFEE S- <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />NO <br />USE SONF <br />101 AREA <br />VACAN1STE <br />DYES D IIO <br />ECt9 <br />YPAMMIIVIV <br />��� <br />- <br />RV:GNU <br />IIEIGNIII IIAOON <br />FA OF DWFLlIN6 <br />UNUG <br />SIIEMBLDf✓fl <br />PIIIMBWD <br />_ F <br />OCGIrANLY <br />GNOUr <br />rq C15'.W{5 <br />OCCUPANI DAD <br />BASFMENI <br />DVFB D NO <br />MFCNANN:M <br />_ <br />ADGIKPIALAMIOQC[ <br />PREB NULRPEO'D <br />RFASON <br />_ <br />OTHER <br />FINER MRED 'D <br />Rr ASOV <br />SIAIEBOIIDW6LIDOIIARDE <br />'- <br />_ <br />9 f <br />TYPE OF rorlsT <br />rinNS APrpgvEDDr <br />�d-�% S <br />nMF /L <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS J105 <br />��7 DTI <br />1,XJ <br />TOTAL <br />