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APPLICATIOL _ FOR CONSTRUCTIE✓N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 07C <br />BUILDING DEPARTMENT HEATINGSYSTEM: UGAS ❑ELECTRIC U__- _. .� <br />2598810 <br />DEMOLITION COMBINATION BUILDING _ MECHANICAL PLUMBING _ SIGN. <br />lwnrtp WL ADOMSS _ CITY !I FYJ1L <br />WL ADOMW <br />UICNTEGIMpEStlI<R MR. ADDRESS CITY N ""OK <br />OFRFpK LOXIRK'IpR MLADOMS9 CITY IIP Rf_lK STATE LSERM• <br />yFCRµICµ LpFIRY,fOp MLAIMM" CITY !W M1IJNE SIRTFLKFNYE <br />I I NEW ADDITION VLTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTRACr PRICE O Raw �fJ�ALw lya <br />CONTACT PERAND Fq d41 <br />oEeCRE'E RdM MED eOIMrt FDD•ME NV0.'IfD <br />/� <br />PRDroefDuff DF euLDPo <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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 />CONTRACTORS LAW IB 27 RCW AND 296.2CO WAC <br />i-- S A/-f2- <br />MOO, OTWRIPTMOF P RTY 161bWV ORLON OR ATTACH I" CCILSI <br />LOT &ocR a <br />- <br />6270 &/cxj4. L✓o <br />P CT ADWLSS <br />sr nI! <br />.vwfil[er6IM <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM I FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSE T ITOILETI <br />A!C-AHNOLO UNITS-H P <br />BATHTUB <br />FORCED AIR SYSTEMS -BTU. M E.A. <br />LAVATORY (WASH BASIN <br />UNIT HEATERS-B TU M <br />' <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />-- — <br />_ _ <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING_ <br />ROOF DRAINS- RAINLEADERS <br />EXHAUST FAN <br />SINK ISERVICE-BAR. ETC) <br />SUBTOTAL 1 <br />SUBTOTAL s <br />PERMIT 1 <br />PERMIT _f <br />_ <br />_ <br />TOTALFEE { <br />TOTAL I'llf <br />_- <br />FOR OFFICE USE ONLY: <br />FRDNE MYIACM <br />REAR RETMCR <br />LDESETMfX <br />0: LHECM MIIAIFR <br />3 <br />II! <br />NLCf VIW <br />_ <br />uSE tox[ <br />LOT AMA <br />YAGWteRf <br />fEEB <br />VALUATION <br />FEE <br />BDAIIAq <br />IKUT KIIND <br />TrRpcoRls uLItRAAI <br />rnf le CpYT ACTDAL <br />EmRftT Av vpwuKL:ro <br />wd <br />N2f DF M W <br />TIC) Ci STOWS <br />IIAWMMT <br />MECHANICAL <br />ADDITIONAL PIAIE CHECK <br />�T <br />OCCAMWICrIMD ilRf fPRMLLERe KOO KMNrIMIAME <br />IIFASM fOp M'RN11LfM <br />SPRINKLER <br />�— <br />BTATE BUILDING RURCTUROE <br />MTAXEV <br />FIMN APPIEDvfDer <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />