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APPLICATION FOR CONSTRUAON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />32DO CEDAR STREET A EVERETT. WA 90201 A 257-8810 <br />h DEMOLITION COMBINATION X BUILDING _ ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />IPROJECTADDRESS 127 t�^7 /�.I.-�� <br />zP <br />PLW13MCONTRACTIXI UAR0DMCS5 CITY m PrgNE STATE UCCNSE• <br />coNTP E °` woPK <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />DE suvIC w.'NIK. .nEEWrA.E MVMVID MF <br />i <br />6 �} <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 ODES 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 />CO LAW 18[/2/7 RC`W^AND 296.200 WAC <br />X <br />Twolros[ 1 s a emlwNa/� <br />LEGAL DESCAPTIDN CI PPDPERrT'l---lan oR AnACN Two COPIES) <br />Lor MOCK <br />PARCELTAXID.. <br />j{ SSO OMT <br />/ <br />CO451DULTKKI IOW LEKEHA ADDIIESS.,CLII`T E H --UP <br />SGNATUP' ID.,C <br />CITYSUSW SSLICENSENCI <br />PLUMBING <br />MECHANICAL <br />NO. I <br />PE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C —A'HNDUG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY RVASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />W000 STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DFAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTALFEE S <br />EPONT SETBACK <br />PEAPSE,BACK <br />SIDE SETBACK <br />RAN CNCLK,AMBEP <br />T[C <br />P2[in1 NJ <br />OSEzONE <br />LOTAPEA <br />v.cANT SITE <br />❑YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />B.CKHA <br />PEIGNTUMITATION <br />UHIATS DKIEW1q <br />fK LCE C, WT1 <br />MWBJW <br />ANcr SOME ES <br />E SPPI PPEBD <br />�� <br />occuru+tyo+B BASEu[NT <br />❑YES VH0 <br />PEASON <br />��tTG• <br />WC"%Cu <br />ILOI1KlN4 rR/N CNFCK <br />D,NLP <br />FXIEAu yIE9O <br />LS <br />PEASON�, <br />STATE BUApNG SUPCIIAPGE <br />TYPE DFCONST <br />F' FnI <br />fly <br />aAnsA ar <br />DATEAt, 00 <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />njvLIcll Pls <br />TOTAL <br />