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I <br />APPLICATIA FOR CONSTRUCTIN PERMIT <br />CITY OF RE EVERETT •BUILDING DIVISION <br />3200 CEDAR STRE�ET�• EVERETT, WA 98201 • (425) 257-8810 <br />fl DEMOLITION ❑ COMBINATION ®'BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: SSOfI S /5t 'q P C/Q�'bT— 11263 <br />So rne- Sa M C S m t <br />-E31- <br />RuueMCONInKtryl miL1AMiCss Cin rm rutY.r SutF l[CMSE• <br />-a <br />Cp11MCI nMCE p Wpny�1� <br />/! 6. as g s� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />pESCRBF WJ1111 FNpSW1 f001.GE NVp1VE0 / <br />`�— <br />o�QO' <br />C flfl,ry PiCW lup r'wCryl Np <br />-r�-- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />ApPLIGfION AND KNOW TIME SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIIL 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 AND I COMPLY WITH THE STATE <br />CONTRACTORSLAW IB2]RCWAND296200WAC <br />/� <br />x/f.y-%���„�-1rrfL p/7 yl' <br />X <br />+arosto psl lM eunm•KI <br />lcc.(lKscmnlKlnamTg+anrr lsloKn eEElm Gn IRACH rvA cases <br />lot f'..%f%.'"�C�elor Q-q], (% <br />P F.1A(IP MMeln <br />COv5TMK1A11101N1-n.MMESS.iCICrIKIMFMMIFn <br />.S <br />E'GN1l1e1E om <br />all WF ASs tc[N E w <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 ITOILET) <br />AtC — HNDLG UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />— <br />WO -OD -STOVE -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 />GAS RANGE <br />_ <br />SINK (SERVICE —BAR. ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL f <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTALFEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />,Am, Vlm1C4 nf•n5lle4ry S.a sr'wHIAOHQM WR llE MfFe'lM <br />a -tar Aw. sl A5127i '92.(1E <br />( A, <br />❑ <br />V1CI1r,vf1 ❑Nt <br />11V1[11 <br />VF[N•Nfll <br />Orls <br />AMIIIW4. MA4 C1✓C11 <br />Od n <br />1111E 01M0wp VW.A.M1l <br />CITY OF EVERETT <br />INN 1..n K% <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />