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1 <br />APPLICADIN FOR CONSTRUSION PERMIT <br />�* <br />CITY OF EVERETT •BUILDING DIVISION <br />3200 CEDAR STREET • EVERETi, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION `�' BUILDING IM{ MECHANICAL �( PLUMBING ❑ SIG <br />PROJECT ADDRESS: SSL// N/�QRFeC:� 4\T In-/ /1 <br />'�'��^' Y41 Ngllr55 f111 !IV <br />+an•ITCI Dn Irt SlraAu uN ANnlF55 nl. :.] <br />YU\ <br />//I <br />to, f olaa% <br />�r .4r-d <br />V+Ir tICFNSL <br />r `4r6, W 11-1 SIAITJKf N, <br />�c'SA��C6�r£lJ HEATING SYSTEM: KGAS ❑ ELECTRIC ❑ <br />wvavcn ralnu n nslw+ro rwwl rm <br />I HEREBY CEPTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />r InK6 PROVISIONS CF LAWS AND ORDINANCES GOVERNING TIIIS TYPE OF <br />:low an Az)!—m oTonf sl WORK WIT BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT14G OF A PERMIT DOES NOT PRESUME TO GIVE <br />a AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />63OTi7'O _ / OTI:-R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />`h PERFOP.NANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />• O00$ APPLICATION IS MADE AND I COMPLY WITH ,THE STATE <br />CON) !A,CTOR;'LAW 11127ACW AND 296200 WA C a <br />rIgNF NUunrn G— <br />:T IunE <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />TYPE OFEOUIPMENT <br />FEE <br />NO. <br />WATER CLOSET (TOILET( <br />BATH UB <br />FEE <br />A7C—AVHNDLG UNITS �— <br />Z <br />FORCED AIR SYSTEMS <br />LAVATORY(WASH BASIN) <br />SHOWERHEATER--- <br />.3 <br />HEATPUMP <br />H6rTEHS <br />--- <br />/ <br />KITCHEN <br />KITCHEN <br />SINK A/ <br />SINK DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE 1100D <br />LAUNDRY TRAY <br />' <br />WATER) WATER <br />WOOD STOV <br />CLOTHESUNIT <br />WASHER <br />WASHER <br />— <br />—�— <br />URINAL <br />METAL FIREPLACE(WOODBURWNG) <br />DRINKING FOUNTAIN <br />__ <br />OOD BURNING) <br />— <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />y_ <br />SINK (SERVICE —BAR, ETC I <br />M—NG <br />�,p.�� <br />SUB TOTAL S <br />SUB TOTAL f <br />PERMIT S <br />PERMIT f <br />FAO nFOnv <br />TOTAL FEE f <br />TOTAL FEE S <br />— <br />F"i [nflAr ____VnrmSrlp[II_ <br />S� <br />G <br />ilw icrir <br />� <br />Immr+ <br />Ilona uMul / <br />No a DWIwNa <br />u4ns <br />ocum.M:Y Yr r..e.as <br />umlm+un u.n <br />JL_. - rv.___ . I o+tt I L/. <br />$IM SES+C\ / <br />11 A404re MlYllrn <br />rf <br />`VALUATION <br />v+cun. If <br />FEES <br />OYES O MI <br />nrl n4. <br />7 <br />a xa:n 1 <br />rumnrvr. <br />9L $. <br />e srwA l <br />O YtS <br />urlYUMrY <br />�— <br />APflllnwn N Clrrll <br />auKn <br />__ <br />r <br />[I+Ir nlnllrwl: Sl Xlrll. n:f <br />CRY OF EVE IETT <br />LOCAL SALES <br />- <br />TOTAL <br />1 <br />TAX CODk 1:; 3105 <br />