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APPLICATIOR FOR CONSTRUCTION PERMIT <br />CITY OF RE - EVE E •BUILDING DIVISION <br />3200 CEDAR STREET EVERETT, WA 98201 • (425) 257.5870 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />WMn4 co%t Ctm MNL 4'plE$$ o" -- )r Plow SIAIftcr"%. <br />NfCNAMC4 CONDIACTOA MALL ArAYE55 (M ?" ftq STAIFLKrNSEA <br />AIM1IBMO CONiRACTOP AIAAADUnE55 an to INTONE StAtr UCENSF <br />❑ SIGN <br />CONrnACt or ATORN <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />nESCM1BE WDIII(ANO Sd1ARF FDDIADE NVOIWD <br />CONTACT PCASDNANp 1'IUIE ND <br />Y/•T HOWL (rl <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 />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CO RACTORSLAW1B27RCWAND296200 AC. <br />PnfllrouousEa wwDlNo <br />IFOAI OESCRPIp1 DE qqI[pryrypCMlppryglARAp1fYA)COp1E51 <br />LDT BLODX a <br />AMID NUNBFq <br />CP'151MCIiDN IOAN ITNDEn ApnRE55. tElCPI10NE MVUBfP <br />ATWE DAff <br />CnT BU9NE55 LCfW ND <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 />AID —AMNDLG UNITS ^ 9O <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN( <br />HEAT PUMP " <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 6 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 />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK(SERWCE—BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />I <br />SUBTOTAL S 1 <br />SUN TOTAL S <br />— <br />PERMIT S <br />PERMIT $ <br />IOTAIFEE S <br />I <br />TOTALFEE S <br />— <br />FOR OFFICE USE ONLY: <br />r11011t SFTBACA <br />TfM1 SF16AC• <br />d cwnIN.'B <br />AANCIIECNMMIER <br />FEC <br />II "vTNO <br />um rONrrONr <br />T01 WA <br />VA fSHE <br />OYES ONO <br />FEES <br />VALUATION <br />FEE <br />nNow <br />MKIRTIMMtm <br />MO a1MECWIU <br />UMfi <br />EICEOr BLDOWT1 <br />R VOBNO <br />�AK.Y NOryfIK45 <br />OfSInYNI IUAp <br />BASFL[Ml <br />3"s O M <br />yr[ryANCN <br />--- — <br />ADdTRXIN.AAN CNf r• <br />-- - <br />FlgrSfn tRRfOD _— <br />nE ASM <br />DTNFq <br />rME NArM PfOD <br />gr4[M <br />SIA1C BIxlON[I SIKCIYn(.[ <br />IrArcCONSf <br />AANSxrrnnvTneT <br />uAn <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 7105 <br />nrEurwDmiS <br />- - -- <br />---- - -- — --- <br />TOTAL <br />