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APPLICATII% FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT •BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 9820101 A(425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑p /9UI DING ❑ yMECHANICAL ❑ PLUMBING ❑ BIDN <br />PROJECT ADDRESS:R % 1/ 0 1 uP1T n1 c D / V�• . t ✓ F v Olt. . L/n c A . <br />G <br />M.VI /J%MIFss C.Iy <br />1 Vn I1f Y[iuln u 1 SS Wf <br />Lenc vur IAh215a0 89-AFc. ��mA..lfIN 4XB�G 4A5 nc-t35I <br />WC14AMCAL C: 41R•CIOn NAZI IICXeS[� %'Alf LCFNREA <br />rI11NBM1G CONIRAflIX1 NIq AI.Acss �111, jIP 11I.W STAIF IICFNSFA <br />d1 A Y-Y/. I <br />Ia wm• <br />A�R �!cl I �JZG = OdS � F-o <br />pFSB'CPmr CRIIA IA Oia LMS Y. IC C G <br />1naJ T <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />_ <br />C A.l r{pSM��y1f <br />5— 'L` /- <br />hI o c� r e aG <br />/; S_ <br />/ { / aye I I N $ I CI A, C C� <br />1 RFO Ov r4 nun ITXXT /� J <br />A C 1 P L.I <br />1 HEREBY CERTIFY THAT I HAKE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAML TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING TIUS TYPE OF <br />WORK WII L 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 TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE A D I COMPLY WITH THE STATE <br />CONTRACTORS LAW IA 21 C AND. WAC <br />ten., lK cmrnoNM rao1Ynry ISFADKN RDOw OR ATIACN PpDLOnIs, <br />LOT R1ocR M <br />D—Gp/�-DOD -05c-G105- <br />w FL uA lO Tawnfn <br />LONSTmcTKX, 10ANTFTpTFP. NY'AIESS 1tIETMO4FMMHT <br />'MNAIWL 1.11 <br />CnY M51NESS lICIMS[ 40 <br />MECHANICAL - - - <br />PLUM8/1G <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EGUNIMENT <br />FEE <br />t <br />WATER CLOSET(FOILET) <br />ArC-AMNDLO UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISP <br />_ <br />_ <br />CLOTHES DRYERS <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />_ <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE - BAR. ETC.) <br />_ <br />GAS PIPING <br />�— <br />EXHAUSTFAN <br />SUB TOTAL S <br />SUB TOTAL f <br />_ <br />PERMIT f <br />PERMIT f <br />TOTAL FEE S1 <br />I <br />ITOTAL <br />FFE f <br />FOR OFFICE USE ONLY: <br />Inml'XIII <br />Pr Rn St1RACR <br />SIM Sf IRACM <br />Iry RN C11[CN NVW(IL� <br />C <br />ITT <br />MCLIrI NO <br />I.SE tONf <br />1o11RER <br />4ACA41911 <br />o rFs ❑ ND <br />FEES <br />VALUATION <br />FEE <br />-- <br />RIPIMM <br />— <br />�/—/\ <br />47W <br />rHId1t IT4IMipN <br />NO Gf [WI[111NG <br />uml5 <br />SREa ntOGrtl <br />'� <br />mOAmmr. <br />OCl:11PANLY <br />Onou <br />MJ ('I Sng15 <br />p:CIMNN110N(1 <br />R1Sf 4LNI <br />❑tI5 ❑40 <br />MFCNAW.I <br />App11RWA11'I AN C,YCII <br />flRf 5m11!Ml[nnLO'0 <br />nFASM <br />Ot Kn <br />FFRE NANMn1OV <br />MASfI4 <br />SUIT BIPIOMIi SIRICIIA L <br />111E flfLle l:O4sl <br />m•41ArrnpvrD BY <br />OATL <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS J105 <br />•+mllr.wmRs <br />TOTAL <br />— <br />