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AP'LICATIj FOR ccmsTRucTIL PE rr <br />CITY OF EVERETT • NALOMD DMSION <br />3200 CEDAR STREET p EVERETT. WA SMI R 2WSSIO <br />❑ DEMOLITION ❑ cOEASMATION ❑ SNSDMG ❑ INECIIAISCAL PLIIEoMD ❑ SIGN <br />PROJECT ADDRESS: , . 4VO / Ln .r / Q.4- <br />wi\[C\oR DESITT.rtR Aw nutss an nP MIDIR <br />t6.FPY fAMfP.CfLR YM MIx1Fpp lli� ]T MQR xIMEIKI M!E• <br />IR• MrJI( (ipti IICFMY <br />HEATMO SYSTEM: GAS ❑ELECTRIC ❑ <br />DEscwM EloIN..D sawn rTnT.Ol .MavYo <br />caRTAcr Ttlyal Ma niOlrt to <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 RE COMPLIFD WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE DRAWING OF A PERMIT DOES NOT PIENME TO ONVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCK LAW REOULATNG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 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 1827 RCW AND 2N.200 WAD. <br />l .�/• <br />NvoMD OSE a suuo <br />IEOM OFMpEIT1OR or MEFERTTISxON.KLON OR ARADR TRO-IX sl <br />LOT NOOK a <br />M MIO MIAER <br />E T1111CTKIR LOIN LEMLFR. p SS. BIER WA*ER <br />Sq.L MlE <br />Onp is I ICEME RO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NI). <br />TYPEOF EQUIPMENT <br />FEE <br />Z <br />WATER CLOSET (TOILE <br />AA:—AN/DIn UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PIMP <br />SHOWER <br />UNIT HEATERS <br />U <br />KITCHEN SINK S DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />MOOD STD <br />/ <br />URINAL <br />METAL FIREPLACE WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIRLPIA(.E INSERT (WOOD BURNING) <br />j <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GIBS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />GAS PIPYO <br />EXHAUST FAN— <br />L <br />1. <br />L <br />rle.+ A1. <br />SUBTOTAL f <br />SUBTOTAL f <br />_ <br />PERMIT II <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />ONCE UEE ONLY: <br />lPfYll Slip.fx <br />PIM {l1NCx <br />5'I1E 5llp.[It <br />M1.R IIRCR.4M11R IL! <br />plCiPI MO <br />uu Mart <br />lol wI A <br />vAcwl NT! <br />`I <br />FEES <br />VALUAl10M <br />FEE <br />DYES ❑.O <br />wcI l O.T.Tw. <br />.o a IRSTuna <br />suE a nl_xn <br />J.ns <br />NIANIYE. <br />_�_ <br />O w.cr toa SIM S <br />a:DOPARI tOAD <br />sww.t <br />wc.A <br />❑rls ❑M <br />N TR InwcMQ <br />EIM SNM.LER MOD <br />WASH <br />OINEp <br />IITEN MQV <br />RF.Stw <br />STATE ft. UM1 V YXY..E <br />mn,RS , <br />_ <br />TrPE or T:o.s* <br />PI A.sA 0Y <br />CITYCITY OF EVERETT <br />LOCAL 511LE5 <br />DATE <br />TAX CODE IS 3105 <br />TOTAL <br />