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APPLICATIO&OR CONSTRUCT& PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 58201 • (425) 257-8810 <br />Cl DEMOLITION ❑ COMBINATION ❑ BUILDING AMECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECTADDRESS: Il[ LO W LIAfwf• \/I,7I DIC.. EV�,CC-TT, Lk,A 11y2b( <br />JIclog'j(IDIjc- <br />01YNEP MAIL XCMI CITY :Ir P L <br />Lo-kGr\co)o c-0(_\tin <br />rENANI MM MIPESS CITY )W P,gNF <br />A"TECI OR VELGNER M.1 A0d1E S on )In "C'VE - <br />w IIMBMGCONIPAr.IM MUI ADOPESS CITY ZIP PONE STAIEIICEN4• <br />cM7c1 PwcE M Woak I <br />O <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OFSCM1BF IYOIYIAIq SOUAM {OOTAOE rrvOIVFO / <br />t .7 LI ��+C.�•Y1l 7 `�' <br />CMliALinaSON AGA)rIIDYF UD <br />o-,T�C�1,4 <br />'_•_'��`_yr <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 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 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 />APP ATION�IS�MADE AND I COMPLY WITH THE STATE <br />CON ACTORS LA iB 2T RCW AND 2%.200 WAC. <br />X )mil^1�—�—G—� <br />rTgrGsruusE M BIwwD <br />IEOAI MSCFTPOp1M FAMIERrr <br />to, BIOcK w <br />Ivncn lu D Mruw n <br />r0V%TRIKnMIwrlFtirfa urnrSS.naraart NUTFR <br />sGNATu1R "It <br />CITY BUSINESS UCERSE NO <br />MECHANICAL <br />_PLUMBING <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />'10. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC — AA/NDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK A DISP <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 />I <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUBTOTAL S <br />ISUB <br />TOTAL S <br />PERMIT S <br />--� I <br />PERMIT f <br />TOTALFEE $ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />I RnNl it rPACR <br />REAP SrIRACI <br />SIM SET BACK <br />nAN crll(Y NUMmR <br />TIE � <br />mr.F.", NG <br />USE IMF <br />t0f AMA <br />VACANT SIT <br />DYES ❑., <br />FEES <br />VALUATION <br />FEE <br />RIFI wNI <br />mMNnmITATpN <br />NO MDWEIIING <br />uxus <br />SUE M lft Vl <br />nuAelNo <br />' <br />OncpTAK.r <br />Mnslw S <br />=WANT IDAD <br />BAUAf NI <br />DYIS ❑ND <br />MFCNAlI Al <br />AMXT10NATMA40NCk <br />i <br />rIM SPNINRIFP MG9 <br />REASON <br />of ER <br />FIRE NMM ROOD <br />WASOV <br />11A1t BUT, UMD SIIRCNARff <br />-- — <br />Tnfmm"T <br />nnaS,rrmrvrn DY <br />% L <br />DAIS 3 —/ZZ'F5 <br />CRY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />nwm—IIS <br />- <br />--A—' <br />-- <br />TOTAL <br />(P f9 I 6,r9 <br />