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APPLICAT& FOR CONSTRUCRON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • FVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />A"CMTEGTMIMSI NER MNIAD 111 nry im ....�.... <br />PIU NGCDNIPA[,TOP MAq ADDEE'S <br />co" IIn VNpNE SGIFIKENSF <br />/- D`5 • <br />CONTRACT P18CE DF;; K <br />-� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />MKPIBF W.]RN AND SOUAPE F00TAOE NVCCYED <br />coYEACF PFRSON AM PNONF M <br />09Z XWIO—' Zo6-7Z6-69Ji0 <br />u <br />I HEREBY CERTIFY THAT 1 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 WIIL 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: AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP TION IS MADE qND 1 COMPLY WITH THE STATE <br />C TR CTORS IAW IB2]R(gl(J AND 100 WAC. 9 <br />X - lf�-?-• / <br />�I(iNA1. .:���VA" <br />PFYMVSFD USE OF 8U1LDIW <br />LEGAL OEBCRIPurnwrRorEPrr ISNONN auowaR AnA[N nYo cOnESI <br />Lm BLOCK a <br />PAPtEI]AKID 1111MER <br />CONSTAKT10N10AN IFMIFR ADDRESS TELETNK)NE NUMBER <br />CITY BU <br />ESS MS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />WATER CLOSET )TOILET) <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />NC--NHNDLG UNITS <br />FEE <br />" <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A OISP <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 AVOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />/O <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />MTOTALFEE <br />AL f <br />SUBTOTAL f <br />SPERMITEE <br />f <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />EPaMi fitlgAPt <br />WAP SFIBACK <br />SIM SETBn. <br />INANC1IECK WMFR <br />fIF <br />RECEIPT NO <br />USE IDNF <br />I OI APEA <br />vACANT g1E <br />FEES <br />_ VALUATION <br />FEE <br />_ <br />OYES OND <br />gInIMNr. <br />— <br />�— <br />IIEIGNTINAM,0N <br />ND of DNELLM <br />IIN11S <br />SIZE OT NDG,1 <br />- <br />PIIIMMD <br />MUYRANCY <br />WNa11 i5 <br />IX;UPANI LOAD <br />Bn$f MEN) <br />"-_Y� <br />PPDIIP <br />MEf.NAnrM <br />DYES 0 <br />- <br />- <br />-- <br />_ <br />FIRESPRINKLER PEO'D <br />PFA[ov <br />ADp110NA1 MANCIVCK <br />011 R <br />FINE AUPM AEG <br />WASav <br />i1AlF BIKIDPRi SIIEI[IIAgP[ <br />_ <br />rvgr Dr roNs <br />1Knesnrrgovf011 <br />CITY OF EVERETT <br />nmur. NORKS <br />LOCAL SALES <br />— <br />TOTAL <br />WE <br />TAX CODE IS 3105 <br />