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APPLICATIOIN FOR CONETRUCTISIN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 • (425) 257.8810 <br />❑ DEMOLITION ❑ COMINNATICN 1I ❑ SIUILDNIO �EECMANN:AL ❑ PLUMBING ❑ SIGN <br />vwnUEeTAmwsaa, 75011 FYar,40SOA) �uAtl <br />h CAI <br />nP <br />OT, 71P <br />PI 11YnMG CwIRACTp VW ADw[SS Clrr tro PN SIAM%CENSEr <br />if,, 9So , ao <br />cwlwcl a wDnR <br />HEATING SYSTEM: ;K GAS ❑ ELECTRIC ❑ <br />DE vpmAw, PE r00% mvavEo <br />1 <br />cw*K: rtRsw ANn.N«INrro <br />Qc/LAI LIA* - fldmo~ lb4vt- <br />"'livw4Fc <br />I im y Nasl gal-3333 <br />i Ic q/•[�J�d( <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 GOVERNPO THIS 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 LOCK LAW REGLILATBO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER CF HS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLIC OK 'S MADE AND I COMPLY WITH THE STATE <br />COAT CTO 'LAW IB 2TRC AND2"200WAC. <br />�._ 94 - 7-11— <br />rnugsro DSr Dr mm <br />IEGAt MKPIPT"Of n n"I511GNNMlr MkTIACH M CMISI <br />loT moRR or <br />PA[CEI IAA. D NAA. <br />C %TVRZT.t(IANIFAiA AnwESS. rtlrlagNEMNFR <br />S.GwTU DATE <br />an m,sAASS I KENSE No <br />PLIISIEINO <br />MECHANICAL <br />NO. <br />TM OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYRE OF EOIIIF mw <br />FEE <br />WATER CLOSET (TOILET) <br />MC—AAINDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />T <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />_ <br />EXHAUSTFAN <br />SUBTOTAL <br />f <br />SUB TOTAL S <br />L <br />— <br />PERMIT <br />SS <br />PERMIT f <br />/ <br />TOTALFEE <br />$ <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />r MMII VIP+fM <br />R(+R [l1PKR <br />P <br />EusErwr <br />Bonn. <br />,v+c <br />FEES <br />VALUATION <br />:EErr3 <br />mRl. <br />❑ W <br />O[IONr VMRAIgh <br />M�1MlE11NG <br />SIIEbmO<1. <br />nl"Nr.. <br />DC�CIW.h l <br />W nSlMll <br />OC WANl lo+o <br />❑r[s ClNn� <br />ADDII(IN.I n.N CIMc• <br />rIP[vnlhMUR no0 <br />mASw <br />OTHER <br />nR[ AIARM RCO a <br />W Acnv <br />-'— <br />SrAIF PIRDMG SIIA^.N.RDI <br />I'm or Iasi <br />nANS.Pmovrnn. <br />CITY OF EVERETTLOCAL <br />--- <br />SALES <br />- — <br />----- <br />DATE <br />TAX CODE ISMS <br />TOTAL <br />