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APPLICAT& FOR CONSTRUAON PERMIT/�/�/�✓���/� <br />CITY OF EVERETT • BUILDING DIVISION <br />0200 CEDAR STREET • _VERETT, WA 98207 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ GU;LD`I/NGG MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:,_��E�EtC A�fE <br />OWNFR 4ArI ifS5F55 CIT, llr rrgN( <br />1ENW1 nOIM 55 lle <br />llr_ <br />AfIGMUGI OR pLGNfR 4An •LIWFS[------tilr - ---- CII� ry �� - 3 <br />GrKnq cwPACTM 4.i11 l.pN1E S$ Crll !Ir IxJNr i1111110ENi{• <br />MECP.MCAt cmin*CIUO \YIN AMP*55 bry llr nglr - GLIr IKrNG(• <br />CDNTnACr MCI OTW K <br />-r-M <br />- _ <br />HEATING SYSTEM: ( GAS ❑ ELECTRIC ❑ <br />MuMar WyJ KK ANn sG prrpO,IGF NMWD 1 1 <br />cp1l.Ci11ns(Yl.wr,10Nr .,u <br />U <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 TIIIS TYPE OF <br />WORK WTIL 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 />OT14ER 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 IS 27 RCW AND 296200WWAC <br />eyMAl - IY 0.11 — <br />FN+pgsfpyv p nun <br />IFGA(peLRrPTII}1p rllGrtnTr lsM7wn enoNGR AHAcu lnq cpnEb <br />LOT nlGca p <br />r F. w10 WWI <br />CONSIPM ITM IOAN t F Mfrn. ADOPESS TE It EM HI <br />HIY eU9NESS ISFNGE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />A/C—AR/NDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK d 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 BURNINGI <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 />EXHAUST FAN <br />SUB TOTAL S <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S. <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FR Tv, TPAItK <br />WARSFIWK <br />SILK Srla.cK <br />PL...c [K <br />qr <br />RFplplA <br />I'm IMF <br />Iol"AF <br />VACANT VIT <br />DIFS ❑ Mr <br />FEE <br />VALUATION <br />FEE <br />AM WF, <br />_ <br />--------- — <br />WKMIIRAIATKM <br />M,p OMUING <br />u4Te <br />S17E OT NOGRI <br />nu4eNn <br />arA111'ANCT <br />ORpIF <br />wPnMls <br />�- <br />I1F.cuMNI Tom <br />eAUwNI_._.._._- <br />One D M) <br />4Ff,NAMCAI <br />AWPMAI MANC14CK <br />---- — <br />j <br />IIWSCMNnLFRKID <br />EIFA!'EIN <br />DINER <br />F Wf A{AR4 N(n'p <br />WAGRy <br />curt euIOAD SIAICIURGF <br />. <br />TvnFp CMNl <br />BANS APINtONrnO. <br />pnL <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 7107 <br />nnu lr. Nvms <br />TOTAL <br />— <br />.— <br />