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APPLICATION FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 R 1425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS:. 5311r� Sp AJe �Ir rt' Cat <br />I��- �, -. .-. �1 Ln 4- `1'I,v.� n I.1 M/u A�nG6 n..rr. <br />ARC fi nCT G10E510MR Yu1 AGnESS C." )m POAF <br />GINFNi G(ININCIGI WMAZOSESS ON 2m MOVE SIAI[IKINYF <br />MF,CNAMGACWTRfiCTGI VYl AMPESS ON )in %KM SIATF ICINS[I <br />AUURRq COT.1Nu:1CP VAR AOOREss GM1 21P ROUE SIMEIIC[NSFI <br />CONTRACT nM1C(Df WG1R <br />HEATING SYSTEM: O GAS C7 ELECTRIC ❑ _ <br />OESCM1RE WdutAMJSWARE ETIOTAOFnM%YFD <br />CONIACI RNSb ANR 11OYT No OOw�nn <br />r <br />nTlonosEO NEE DF WR.oIIO <br />_ <br />t r <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />W <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />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 70 PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296201 WAC <br />X <br />N TNO COR[si <br />IraM DTSCRPnW ar nTloPEnn lsNorm etlowwAnALNOT. <br />tot &OCR Or <br />nNlc[t uXm NUNRrn <br />CONSTfi141MMIWN[[HIFR,1Op1E55 RlEINONE NONOFR <br />SA]ANTM OAI[ <br />GII BD9KSS [GINS[ W <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 />NC—AAMDLG UNRS <br />BATHTUB <br />I 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 />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />DACKFLOW PREVENTERS <br />GASRANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />�— <br />EXHAUST FAN <br />SUBTOTAL s <br />SUBTOTAL s <br />_ <br />PERMIT s <br />PERMIT S <br />TOTAL FEE s <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: l-'lnv 4. l.a le C7 <br />NVINI AEMACK <br />WARUIRACR <br />SIDE srlsAA <br />PANOSCAA%-1AAWA <br />rFF <br />IF rRPT No <br />} <br />�(� <br />j -/ � / <br />'IS[IONF <br />101 AMA <br />YACAN\911 <br />FEES <br />VALUATION <br />FEE <br />DIES ❑No <br />RVROMO <br />� <br />N[IONIIMIAIOY <br />mOF IMIIINO EsIlF MBIMRI <br />'ItNA KI <br />Ii <br />CC(:111'AVCI M(A SIfwfi3 <br />G:f.11n4111DAP BASFwAI <br />—_— —i— <br />['AIDIIP <br />4FLM11K,4 <br />_ <br />(]Its El ND <br />ALOIIIONAl AA400Gt <br />FXK SN111FLCR Moo <br />rFASG\ <br />OI R <br />T9IE AUTRA RtaP <br />mssRY <br />S\Alr Rlnt[MO sIRILMAPPf <br />./-- <br />i �1 G <br />1n40f r;pY[t <br />MANS• FoBI <br />I( Z� <br />CRY OF EVERETT <br />nrnl r.won-5 <br />1 <br />`1 <br />LOCAL SALES <br />VMt <br />TAX CODE IS 3105 <br />TOTAL <br />(J <br />