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APPLICATLON FOR CONSTRUCAON P[RMI'T <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, VIIA 9822001 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING L5 MECHANICAL ❑ PLUMBING 11 SIGN <br />Courn.cr VEYCEQQ— <br />��Q <br />HEATING SYSTEM: Cl GAS ELECTRIC O <br />CESCaoF w'JPRA SOU.n(I OOI.c[wVgv[ o <br />Ti.ISia II New ReoF Top RTC. L9m �' _ <br />C cr ITnSON Im rINJNr Iq <br />nal �12atA LV <br />ASSCICAA�e b0c6J _- DL ref-5 <br />�ASRI� Ne{.J 1 <br />r•Ia^ro�sf^o l`15[_nr unmNn <br />SPaC� <br />[[GU DESCRmuol, Of PROPEn Y IVgBN OEEOw OR ADACO IwO conks, <br />LOT OEDCR Or <br />4a5 bba as`js <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW 711E SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TI/IS 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 OF 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 18.27 RCW AND 296200 WAC <br />X <br />/� p <br />D �p ii C) f S ODD <br />PAncO FAA l0 ImuREn <br />coNSTalcrnNLOAK IFNnFn. AOm[ss. r[urNONE mnAOHI <br />'_I1111AIIn1E E,[1[ <br />C11Y tlULIIESS LSI Ntil I.D <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />_ <br />WATER CLOSET (TOILET) <br />�— <br />;V—Al HNDLG IINRS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />L <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />EATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL RREPI ACE (WOOD BURNING, <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />_ <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />�— <br />EXHAUSTFAN 0 <br />SUB TOTAL $ <br />SUB TOTAL S <br />PERMIT $ <br />PERMIT S <br />TOTALFEE $ <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />rMNTSFTRACK <br />An SFwc. <br />SIDE SCIELWZ <br />AAN CE ILEA ..r, t/ <br />1!r <br />nE CFIr1 NO <br />USE l"F <br />IouNFA <br />v.CAIR wir <br />FEES <br />VALUATION <br />FEE <br />_ <br />❑Ya nND <br />_ <br />11EICIU IIu141RY1 <br />No Or OwEIUNG <br />SIZE M Rlanl—--- <br />rHMRING <br />�� <br />IM11$ <br />NCY <br />OCC„I <br />nn)IIV.IS <br />fKCUPAN110A0 <br />B�Sr 4QNi <br />IMp <br />NrnI,AN,11A1 <br />OYFS OI, <br />AOOIIKWAI nWC1Yr.. <br />—" <br />NPESPRPIMENRETo <br />TIFARON <br />FIREAUr1YRLo'o <br />SWt mAIU✓n. nrvlunof <br />refrK coin, <br />ArNlovrn or <br />CITY OF EVERETT <br />rum n: wm�Rs <br />LOCAL SALES----- <br />--------- <br />-- <br />UMk <br />TAX CODE IS 7T05 <br />TOTAL <br />