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APPLICATION FOR CONSTRUCTIVN PERMIT <br />_��r;;. . CIN OF EVERETT• BUILDING DIVISION � <br />:5� <br /> 3200 CEDAR STAEET• EVERETT,WA 98201 • (425)257-8810 <br />'�" � ❑ DEMOLITION ❑ COMBINATION � BUILDING ECH,ANICAL ❑ PLUMBING ❑ SIGN <br />�= P ECT ADDRESS: /O C�o�b !�*�/� <br />� ��p�1� � OZ <br /> O EN MML�OOPES$ Cltt Z�� PNONC <br />=�- (a/�rdr� i'���r/l�P Y�io lo�,�.���T� �,v� <br />���` I�EnN�vt L��R�DDAF55 clr Av PHONF <br />,� , n'9/>�/ ��l`1i7�-G� <br />- � �AC Tfc oR DESIGNLn M�R�onAE55 crtv 7�r rNONf <br /> ,,, _ �/O.Q/C/7 7^iP�"-il�S �a��//_ l�// �l3 /�3 <br />�'�` � ceN¢nni cor+mnctcar Me�i nooncss enr �m mmv[ s�ntc uerr+se� <br />�`T. � �8�.�ql�mS ��y S,vE �s'-'-`S�` ��of�F�i/ �v�r �i/ �BSYST�o�as <br />� <br />'� �� ' S�ZS=s��2 -��8�/ <br />�'.i�� � �MBtt+GCONiR�fiOP M�ILAOORE55 C17Y ZIP PMONE 51ATGUCENSP� <br /> .�� <br /> CONfR�CI pRtCE O'WOFN HEATING SYSTEM: G GAS �ELECTRIC ❑ <br />��'d l <br />�. DF.SCRIBE WORK AND$OUARE FOOUGE nNOWED CONTACt PFRSON�NO PNONE NO <br /> '::� �✓C��nBt �/l�/C.?/S 70 /��O/y10D�[� <br /> '� <br /> ' '� i QtFt/ /F�/lC7N� G/¢ G�% rQ0 6'C� � HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> � � raoroseovsE oF euaoivc PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WIIL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br /> ��� IEG�L0E5CPIPTIONOFPROPERttISHONMBELOWORATfM1GbTWDCOP1E51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> �.�� ��' qUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY <br />� '� lOT BLOCN OF <br /> . � 07HER STATE OR IOCAI.LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.TMAT I AM AUTHORIZED BY THE <br /> OW�EH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> II — APPLICATION IS MADE AND I COMPLY WITH TME STATE <br /> PARC[LTNtID.MIMBER CONTRACTORSlAW1B27RCWAND .200WAC. <br /> CONSTRIIGTION IO�N lENOER./�DOR[55.TElE1'NONE NVMBEP xL/6"����'��/�'(� V�'�"' ' " " <br /> SIGN�I'lIR[ D�i[ <br /> pT\FUS!N[SS I ICCNSC NO <br /> PLUMBING MECHIIR�CA1. <br /> NO. TYPE OF Fl%TURE OR ITEM FEE N0. T't`E OP EOUIPMENT FEE <br /> T <br /> WATEH CLOSET(TOIIET) � A/C—AMNDLG UNITS ' <br /> BATHTUB ' FORCFD AiR 51'STEMS i <br />, LAVATORY(WASH BASIN) i HEAT PJMP ' <br /> SHOWER � UNITHEPTERS � <br /> KITC4EN SINK d DISP i CLOTViES DRYERS � <br /> DISHWASHER RANGE HOOD _ ' <br /> LAIINDRY TRAV � WATER HEATER _ � <br /> CLOTHESWASHER � WOODSTOVE ' <br /> URINAL METALFIREPLACE M'OODLiURNING) ' <br /> DRINKING FOUNTAW { FIREPIACE INSERT(WOOO B:JRNING) � <br /> FLOORDRAW � GASPIREPLACE : <br /> GAS RANGE � <br /> 6ACKFLOW PFEVENTERS � --�-- <br /> SINK(SERVICE—BAR,ETC.) GAS PIPING ' <br /> EXHAUST FAN �_ <br /> � � <br /> � <br /> � — <br /> — 1 SUB10TAl F ' <br /> SUBiOTAL E ; <br /> PEiiMIT E � PERMIT E <br /> TOTALFEE S ' tOTALFEE E _ . <br /> FOR OFFICE USE ONLY: <br /> IpONTSFTN�GK Rf�f15FiB�CN SIDESFIB�CIt PI�NC�IiCKMIMPfR fFF RFf.E��TNO <br /> use 1or+F io��n[e vnc��+t 9�E FEES VALUATION FEE <br /> i <br /> pvES � NO BUIIbMC. <br /> NEIG�711MII�iION NO Oi DwELIIN(S 512E0�6LDG/11 i <br /> IINIIG pIVMflIYG <br /> _— — � <br /> OCGUPI1kCY NO 0�SIt�RikS IX:CUPRNt LO�U B�SEVENt NFf.NANlf.nl i <br /> cnour — — <br /> OrEs O M� ' <br /> •DDIIIpt1Al.�IAN CMf.CN � <br /> (IR[SPfVINKIGR REO'D �fA50N — �— <br /> On�EA � <br /> fIPE AIAPM FC9'� RFRPOV � <br /> 51�1f AIPIU�NG SURCIIRf1GE <br /> trreorr.ousi rtnNcerraovroer CITYOFEVERETT rur+ur.wnnv.c <br /> LOCAL SALES -- — <br /> �ATE TAX CODE IS 3105 70TAL _� <br />