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APPLICATAW FOR CONSTRUCtON PERNIT <br />CITY OF EVERETT N BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA MI201 •2"10 <br />O DEMOLITION [I COMIMINATION BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br />PROJECT ADDRESS:�/3-'� - <br />ftu�cm]RY.,U U. YlL ss CITY 1R 1"KM[ SIAIE LKXNY• <br />CONIR.LI.M:E d <br />!Q 24, ! <br />HEATING SYSTEM: Cl GAS ❑ELECTRIC O — <br />p SOWfN AOfIWA9l Ti... <br />1'(Ix1.CIn Md1 Y111h4f M0 <br />LAS-111"Rv 1&rc+'! D.¢.5K 7-G L-SJ <br />2)o Lpy jF <br />I / <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNFq THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO DIVE <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 AUTHDRL2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK MR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT TORS LAW 18 21 RCW AND 298.200 WAC. <br />�l 9 l z c <br />;;z, o m p w --- y <br />M c nF /G <br />nAL LEpw T IN � nn I,Nd xxtmm.11.Ex 1,.ocomER <br />Lot N11w d <br />MIC[L 1M I o InIYRn <br />w,n,KINn10Y 1ExpR. ss <br />11 w1E <br />CIIYFUSN45S'_CFNM NO <br />MECHANICAL <br />►LUBBINO <br />MO. <br />TYPE OF RXTUILE OII I7EY <br />FEE <br />MO. <br />TYPE OF EOIIMBw <br />FEE <br />WATER CLOSET (TOILET) <br />NC—ANNDLD I11NTS <br />BATHTUB <br />FORCED AIR SYSTEMS <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 />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 />SACKFLOW PREVENTERS <br />(il RANGE <br />_ <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL ! <br />SUB TOTAL f <br />PERMIT ! <br />PERMIT S <br />TOTALFEE f <br />TOTAL FEE FEE <br />ES <br />NLY' <br />OFFICE USE <br />O <br />