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APPLICATION FOR CONSTRUCTION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />1200 CEDAR STREET • EVERETT, VIA 98201 • (425) 257-8810 <br />-P"E P UMBING n cicN <br />❑ DEMOLITION ❑ COMBINATION 0 BUILDING ❑ MECHANICAL L <br />PROJECT ADDRESS: (u I L+ VT'V IVL � AV C • E-V ldrL�f W)l 9 S Zu/ <br />�— -,yam 4If zS; —vso0 <br />. e... u. V4lrldn Si CITY <br />IT <br />— <br />conrnAclm¢EOFwwK - <br />L�'�L{1L <br />HEATINGSYSTEM: IAGAS ❑ELECTRIC O <br />l KYii�O( <br />Lw rwoMF uo <br />AK <br />oF.,cn�xi w�ava AMo sou(oo( <br />cwdcr rrnsw <br />1 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 ORDINANCE . GOVERNING T1415 TYPE OF <br />Iralrosro ln(M mmdla )s <br />s,�,,, , <br />FlY Tn�` <br />WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />TAPERMIT DOES NOT PRESUME TO I VE <br />NOT THE GRANTING <br />rY.Ocd+lN <br />t(du pLSCdPrrOnv rnJPERnINdnl!(LOnwARAcx <br />VIOLATE OR CANCEL THE PROVISION OF ANY <br />LOT !LOCK <br />AUTHORITY <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 />CONTRACTORS LAW 19 27 RCW AND 296 2DO WAC <br />PAPER IA.IP MIITFa <br />CpY51aULTKM IOAHIfNLfn. ARMK55. i(l(AgNF M1NMFn <br />X_—�- nnH <br />SR III C <br />GTY N)SIMSS IKINSf Mp <br />MECHANICAL - <br />PLUMBING <br />OR ITEM <br />FEE <br />NO. TYPE OF EOU!PMENT FEE <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />AC—AHNOLG UNITS <br />FORCED AIR SYSTEMS <br />BATHTUB <br />HEAT PUMP <br />LAVATORY (WASH BASIN) <br />SHOWER <br />UNIT HEATERS <br />CIOTNES DRYERS <br />KITCHEN SINK A DISP <br />RANGE H000 <br />DISHWASHER <br />WATER HEATER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />W000 STOVE <br />METAL FIREPLACE 0V000 BURNING) <br />URINAL <br />FIREPLACE INSERT (WOOD BURNING) <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SVB TOTAL f <br />SUB TOTAL f <br />PERMIT f <br />-- <br />PERMIT f <br />2 <br />TOTAL FEE f <br />TOTALFEE 3 <br />FOR OFFICE USE ONLY: <br />IF <br />Io'Nw. <br />❑ M <br />___ <br />MANSE.. <br />Imim" <br />MU a PEARL— <br />t9A!"! <br />VH'.AACADM <br />_ <br />A(Idll[IMA RAM CMdI <br />(lAl( Mr10rIn 51111GIAlIfK <br />CITY OF EVERETT MMr. YrtK.Ac <br />LOCAL SALES <br />TAX CODE 15 ]105 TOTAI. <br />