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APPLICATION FOR CONSTRUC*001 PERMIT <br />CITY OF EVERETT R BUILDING DIVISION <br />CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION J4 BUILDING Ya MECHANICAL 41CPLUMBING ❑ SIGN <br />34x- 1735 <br />c,A&,&2e_ <br />AALNtro On I <br />PeFali tHeg„r"e 1gims-sal-I8a7 E'eti„PSI itmstt <br />P,I WING CON I.AfrCA W9 A:Yla6c Cr; br rNOR 514E ICIKf. <br />coNryn.cl ynv-�cL M woaR <br />HEATING SYSTEM: AS ❑ ELECTRIC ❑ <br />MS[p11r AYll wu.ar. .GlGr Wvavrn —_-- <br />JNGIv-1 <br />cCN1AC Ina50N.M 1�1ND _-t= <br />/ LACY <br />__'1J.G.%�O <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 7141S 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 10 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACT P: LAW I827 RC AND296200WAC <br />6/ <br />X ���� / " <br />INKKroSFDtI<t MmADNG <br />LEGAL PESCDP1roNM PIOAPA ISMIMI RLAOW aI.TuulrJwLoa�onL_jyp'_� <br />LO'".32•ZI mm. COS Or /AiY "10 <br />L' aC)kc �.y.h co <br />—`L..A� <br />fwlcA tAR l o .uNRLn <br />CbISIPtR: rION IOANIfNIIra ADw[SS RIFM1gNENWPFa <br />.HAT VIII NAiI <br />�� <br />CaT W4M c51Cl NSL IQ _ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) /f <br />A/C—AMNDLG UMFG <br />� <br />BATHTUB / <br />FORCED AIR SYSTEMS / <br />/ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS _ <br />KITCHEN SINK A DISP / <br />CLOTHES DRYERS / <br />DISHWASHER / <br />RANGE H000 _/ <br />\ LAUNDRY TRAY <br />WATER HEALER <br />WOOD STOVE <br />CLOTHES WASHER <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />Z <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />--� <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />+_ <br />SUBTOTAL S <br />SUBTOTAL f <br />PERMIT S <br />PERMIT f <br />TOTALFEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />rPONI vr�R^.vr <br />Lrw sF'10^Rf <br />smE urlACR) <br />nRNn<C•N��� <br />[f� <br />11 <br />usL lONr� <br />ID1 APfA <br />vAt Vt LIE <br />FEES <br />.IV <br />1 <br />.YICJIrHwMiRW <br />NDa IuN <br />SNfaRlOG91 <br />wr... <br />GCI:tOAht:t <br />M`ncNytl <br />mcw.N, tow <br />RAt V[hl <br />f.00M <br />AOOIdE1 nA4 C11Gr <br />fbIF5PM.1alENRFHD <br />IFISON <br />OIWP <br />Fw_ AUJIMPLOO <br />Rf1FDY <br />SIMI MMDMtfI,Ai <br />I'M MC", <br />CITY OF EVERETT <br />n;m K.wMv1 <br />�..{_ <br />0 -AI <br />�.,. /�/ <br />LOCAL SALES <br />TAX CODE IS J105 <br />^--- <br />TOTAL <br />