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APPLICAT& FOR CONSTRUCON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 5 (425; 257-8810 <br />ty <br />,QpM) #UOr+ ❑ COMBINATION ] BUILDING ❑ MECHANICAL ❑ PLUMBING Cl SIGN <br />PROJECT ADDRESS: �� Li ✓spji EgnEfr�Y cA '19Za If <br />Swxr - S 5/Il <br />QhrRn—'WMf55 OA I <br />W <br />•IYlflrCl dl Of LGrh4 u"MOm55 dlY FIT' "r" <br />SET-P <br />pLMLn.1 L041NL1p11 4.11 .IXI4L5$ CITY hr ANYh SI.1l 11CIN4r <br />Ve'Cw.MICN t(MIR.f,IOn V.M1.OIYIf 55 dlY IIr - PIUwf SIATr LICENSE <br />M1VVEMO CPIInSCIW VAM1 IOUwf55 CITY IIr PIKTd SiAtf ICEwSF♦ <br />r rIn.cl lwxcLawwS <br />HEATING SYSTEM: ❑GAS El ELECTRIC ❑ <br />1lr ScnieF w.wa Awo sourM rppiA4tn Ko <br />� Gk51ri� � F.n.ic <br />Lwlxl AaSow.Mr M y2S <br />,��, � 2S7 - 08� <br />_ Rwr+o✓sJ(s <br />$N6GT12:Ot� iA.-2 OU S:C <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW TILE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />1•ndojj,�ro ust or n�mdM <br />ICL?i 1a p+7-4-A - <br />WORK WILL DE COMPLIED WITH WHETHER SPECIFIED HEREIN OP <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />TRIAL IXSLMPV aA HTI 14—MLOV In.nK41N9 Tsl <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />to, um. <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 P9RFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC70RStAW 1pnPI7ND 296200 WAG <br />9�3 �55 <br />^.nCfl iAl II MMMn <br />cONSr111K IKMI TOAn IrMFn.lpMlfss rH[HIdIFNWMRn <br />. _ <br />% .IUIC D.11 <br />CRY IIU9MSS LFf III[ M <br />PLUMBING <br />MECHANICAL. <br />NO. TYPE OF EQUIPMENT <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />AfC—AMNDLQ UNRS <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 DRYERS <br />DISH WASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE BVOOD BURNINGI <br />URIIML <br />FIREPLACE --INSERT BURNING) <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />GAS FIREPLACE <br />GAS RANGE <br />T <br />BACKPLOW PREVENTERS <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL f <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE $1 <br />1 <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />FMY1\QrR.fh <br />W.P SfIIK[ <br />SICF S[IIK. <br />rt.NdRCR MMIfn rFF <br />1R[FIrIM <br />u5E lI4F <br />Im.afA <br />F <br />Vx.w191F <br />❑Y1s oM <br />FEES <br />VALUATION <br />FE_�__ <br />— <br />_ <br />aulAwr. <br />imMlIWAFON <br />MIP 01WLLIM <br />SII[MI.. NM <br />rt1ATu0 <br />____ <br />wcd.H <br />Ll<,dpArICF 1p Aflfgf <br />QCI ll1MV <br />I.N4[NI <br />Appll(MI4 NAN CIIFd <br />_ <br />MIGII' <br />�— <br />DffS DM <br />FIM BNbMtfn PErYI <br />MASFM <br />OIMn <br />rim NM4mom <br />FIF.SM <br />SIAII nRlldwf151111L11AMF <br />nmlr a[Kn5 <br />__ <br />lm lx[.u45r <br />rtAwSArrnuvrnar <br />CITY OF EVERETT <br />LOCALSALES <br />-' <br />nAll <br />TAX CODE IS 3105 <br />TOTAL <br />