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APPLICATI&I FOR CONSTRUAOR PERMIT <br />CITY OF STREET <br />•BUILDING DIVISION OL <br />3200 CEDAR STREET •EVERETT, WA 98201 • (425)257•8810 <br />Cl DEMOLITION ❑ COMBINATION BUILDING ❑ MECHANICAL ❑ PLUMBING U. SIGN <br />PROJECTADDR_ESS: 1-1 <br />IrN•NI <br />uM NmKrf <br />an <br />>A <br />%•"Yf <br />11CNTGI OI1 EILp1rR <br />Y111 .1�p{S5 <br />Clrr <br />lll' <br />OY11M <br />AIIA <br />pfWNI CUN11YG q1 <br />NIA <br />YN IryMIr{S <br />_ <br />al, <br />__ <br />!✓ <br />%•IV MAIL 10"Is <br />YFGYFMGY Gd IOA <br />AIJ A <br />YM AOO"1 sf <br />aM1 <br />to <br />gtlNf anlF IKFNM• <br />%IWNA CONIPY,IOR <br />YM YIOINs{ <br />L <br />jV <br />n191r SMIF I ICFNSrI <br />r1i, <br />CONIW IHIILI M[11Y <br />irr <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CPYIKI MINON.M%I(IYiM <br />RSCINF WOIfI• %•O "hA M'QHO ---_ <br />Taw-i-Tr�r.trT�_y r'.'1 �• 39iy Z4 <br />o <br />i9orovP �• <br />If" OfKMPIKN Of tMlsKrriMOKM F[IOIIOKAn•CK lrq G9ltH <br />If11 �.. Od <br />: <br />I HEREBY CERTIFY THAT I HAVE RFAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND MA14ZCT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK VAI L BE COMPOEO WITH WHETHER SPECIFIED HEREIN OR <br />HGI THE GRANTING OF A PERMIT DOES NOT PRESLWE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVII. ON OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUtw.'li1TE0 BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOH•' FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT CTORS LAW IS 22 RCW AND 2" 200 WAC <br />x •� � ��_ [�-17-9q <br />�1]�•(�'Y\-Q(� <br />1•wCEL IU ID MIIIMK <br />CGYSIAIIGIpHOW HIAKA.awn%IfnaW IAA+FK <br />N �A <br />ey. uN u.N <br />arr IKt%tss HcFw M <br />PLUIMING <br />MECHANICAL .—.—.__.._ <br />NO. <br />1 WE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF ELTUIPM[M <br />FEE <br />WATER CLOSET (TOILET) <br />CATHHIS <br />bC-AAINDLO UNITS <br />_ ' <br />—r- <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />LAVATORY (WASH BASIN) <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK f DISP <br />CLOTHES DRYERS <br />DISHfFASHER _ <br />RANGE HOOD '- <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />_ <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />_ <br />GAS FIREPLACE <br />GASFIANOE <br />- <br />_ <br />BACKFLOW PREVENTEAS <br />_ <br />SINK (SERVICE_- GAR. ETC) <br />_ <br />GAS PIPING <br />EIOIAUST FAN <br />SUB TOTAL f <br />--- PERMIT F <br />SLID TOTAL S <br />PERMIT f <br />I <br />_ TOTAL FEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />IPIN.rvLC� <br />pM Sf if•Cs <br />fFK MIMC• <br />%W CIKCa rA1W <br />!(f <br />Pifl►1W <br />IR[ <br />lo1' Jy <br />W"'SIrF <br />FEES <br />VAL ATION <br />FEE <br />--•— <br />WKWI IAIgN/ <br />MOfAM Iq <br />UYIf <br />H2fwk <br />tilt <br />%IA•IYfi <br />WI'N1M'4 <br />.• --�— <br />fµi/NNC, t,nr1141! <br />PY11MN IOW <br />NS(WNI <br />fWll[M4 %Wllff.• <br />fKr 6nM1AUa PFO9 <br />—_ <br />OrfWN <br />OIMM <br />1•K •uAM MOD <br />nn rrF`}°"`I <br />Y-IJ <br />_ <br />III •aOv <br />%•"s.°nlmr°°' CRY OF EVERETT <br />OCAL <br />wrt (•o t 99 TAX CODE S3;05 <br />f 1Y1 IIw LMfI rl%aMIYK <br />�� <br />n�r.wds <br />TOTAL__ <br />--' <br />