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APPLICATt0A FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR, STREET r EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ CJMBINATION ❑ BUILDING [$MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDF <br />.ACIAt[CT OF DESlGMR MAB ADCM5% atr rm PNrnr <br />AIIYBMG CDN1pACt[p MAP AIXII an :11 M t SIAIFISFNSF• <br />CONIpAC11'INC[ OI wV y � <br />92 Si7n � HEATING SYSTEM; Lp�GAS ❑ELECTRIC ❑ <br />I>�scnBf WMKA SOU RE FOpt ErFY01VE0 <br />Cd IACt rI111". D r ND ` <br />hlA nil <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESOME 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 'WOf% FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONI RACTORS LAW 11822JT RCVV AND :96.200 WAC.O (� <br />PnOFN- <br />OSfDUS[ a Bdld <br />«aP mwpiptm or lYlOtsm IPIOwN BEIOw oR AUACD two COwESI <br />tot BLOCII a <br />PARCEL IAB I D MAIN, n <br />CON%7MIETId1100% 1 EMIfR ADM[ SS 1EI Etl NM FP <br />sA: Al R. EAlt <br />City so1w SS ICENSE ND <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE Of EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AID —AMNDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES URYERS <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 />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SER'/ICE — BAR. ETC.I <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL f <br />SUBTOTAL S <br />PERMIT f <br />t <br />PERMIT f <br />_ <br />TOTAL FEE S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />I mW Y,PA,A <br />MA11G MAE. <br />S'M PFIBACB <br />PI ANCIILCN NIN7PFP_ <br />{(F <br />MfFIPI NO <br />ucf rrnF <br />mupfA <br />v4Awt ylE <br />FEES <br />VALUATION <br />FEE <br />--�— <br />BUItANn <br />OvFa a <br />I41dp IMRAIgN <br />wD MMIDW <br />sat a N0d11 <br />I <br />,MIS <br />Iy LIM111Mi <br />{ <br />UI:I:I B'AVI:t <br />IXT <br />Mntl(v15 <br />IX\'IFANI (DAD <br />BANA(HI <br />4{L:MAM(M <br />I _ <br />OIFB O VO <br />AdvtmNu (TAN dXCP <br />� <br />nm sPum. .P rcoo-- <br />MASH <br />OIN P <br />I I111 A4fN Nto <br />Pi Af(W <br />Snif PIA1tMAt SIXYIIAMF <br />I <br />IIIT MrpNit <br />nAv6Arlrgvrn By <br />CITY OF EVERETT <br />rllNc wanvS <br />—�— <br />LOCAL SALES <br />DAtt <br />TAX CODE IS 0105 <br />TOTAL _ <br />I <br />