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APPLICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, VIA 98201 R (425) 257.8810 <br />rSEMOLITION ❑ COMBINATION BUILDING WMECHANICAL ®PLUMBING ❑ SIGN <br />PROJECT ADDRESS: 1011,C) CV C262rZ�w�A1 W My <br />y nzs AOORA'v I \AIY7:i 6Nr[_R[ra VVEr�A.f►�1 Eil�� 94'Wi IZOcJ 64l•0096 M*r IU <br />avnrn uu�Ess Gn nr rroNE <br />S A.t+l L <br />I[NaHI Y111 YIOM. ss GIY )p MgNr <br />_9 to K'pA--YL <br />IIRCwrrCr On lRyfllfn Y1n ad'Inf ss GfY )m r,gwd <br />Cn WA <br />GENUUI CONITInI{TMrCrl YUI ApINI[55 Citr pr Axrvt c41f IK[Bur <br />WCnEMCµ CW AACrOR MMLAOCTFSS Clh jil' rI VY.I Vµr lC[N$• <br />_ V w!Y`A.Q%4— <br />N.W.GCd11RAftg1 Vr'1 AI%HEsa « CITY DO, 1`nWl SIAIr110ENSIr <br />1b co <br />CWIIUCI nKEW a <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />W w MjMANo ILO rpplACE r1YVlWD <br />lxcwn2 wE <br />CWIAC I rI." AM 11"I Np <br />-GGatA,acF[ Anat.e+_.�y]fol 4ll br79 <br />STTLOC.vo L-E.TY-c_ Ro IL T3cco s-Orr <br />1 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 AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOl PRESUME TO GIVE. <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTKN OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATIO14 IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L AW 1827 RCW AND 296200 WAC <br />X � <br />WIUIUIL lYl( <br />rFror'osrDUE a tnamw <br />lfDAf ascdnllW a rlgl4nrr isawN euOvrw AnAcu rwo taus <br />LOT &mx or <br />qxuu/I Arun <br />CDNSIRIK:IKINIwMIrNIKn µa'Mss t[lfP+y,E R <br />MY". SS IKINgM <br />MECHANICAL <br />PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />EE <br />WATER CLOSET (TOILET) <br />NC—MINDLG UNI7S <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />WEn <br />UNIT HEATERS <br />_ <br />KIT N SINK A DISP <br />Cl OTHES DRYERS <br />DISHWA ER <br />RANGE HOOD <br />LAUNDRY Y <br />WATER HEATER <br />CLOTHES WASNER <br />WOOD STOVE <br />2 <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />DACKFLOW PHEVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT t <br />_ <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />Ir TU"ACK <br />W.Vtw. <br />wwlw. <br />N.UKCO, M . <br />- <br />NF <br />IYfI II'I ND <br />uu TONr <br />AIMKWM1) fI(WIS <br />rRE StmIx12R I¢DD <br />N7 <br />nx AfAMA REDO <br />Niro <br />IDI AR[A <br />NAUNt yrt <br />Orta ❑ "' <br />FEES <br />VALUATION <br />FEE <br />__---�i� <br />�I� <br />I <br />---- —� <br />nnwrO <br />_ <br />d0Q—_ <br />NIKOalDsr p1V[(l�lMq <br />_IKKWrAfNACR1r <br />SIlE OI M0Of0 <br />nNICRNAnY.arDC <br />CICCWAt MAD <br />SAVWVNI�I1S <br />NR <br />µ <br />AWIIONµnW OCOI <br />I1f aa0N <br />OIn[R <br />RfAKW <br />alAtf SIIRpNO PXCturtY <br />I'm of CA, <br />I _ n <br />F )L <br />FlE <br />wIL I <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />nwr.v % <br />— <br />TOTAL <br />--- <br />