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APPLICATION FOR CONSTRUCTAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT. WA 98201 r (425) 257-8810 <br />❑ DEMOUTION ❑ COMBINATION ❑ BUILOMNi ' ❑ MECHANICAL ❑ PLUMBMM] SON <br />PROJECT ADDRESS:•ya.T- <br />RO <br />an �— tin rNolf sulrlgrnur <br />craw IMCCa AvaN <br />hIEATIND SYSTEM: ❑GAS DIELECTRIC ❑ <br />D6;NM M)1e( AID sWVDl t(p110E INVOLKD <br />-ZZ/A IV t'�CS!-�3 �,�_ <br />c]IACIMPSCNAMIPw 'p <br />�e 7lr'd1E 0I7J�ARA <br />y�7-�yyG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />rlDrosrD us[ a RINNY: <br />��•�' �rdf -(N <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />ircAlrcuMmrona ImpSntr lRgeN nLraR CRAnACN lrq cmCsl <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />Dn NOce a <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 TINE WON( FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296200 WAG. <br />twgM 1.ID <br />COsTWCTIDNLCANtrMlrn AMYwSS n.rIMOh MNKm <br />DArI <br />n AUSS ICFNST NJ <br />OI <br />ayE <br />— <br />PLUMBING <br />YECNANICAL <br />NO, TYPE OF FIXTURE OR REM FEE <br />NO. TYR OF EGLIM'fIB/T FEE T <br />WATER CLOSET (TOILET) <br />AID —AAIALG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S 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 />FIREPLACE INSERT (WOOD BURNING' <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />GAS FIREPLACE <br />SACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL S <br />SUBTOTAL f <br />�_ <br />--- <br />MI <br />PERT f <br />PERMIT t <br />_ <br />TOTALFEE S <br />TOTAL FEE S <br />�l_ <br />run vrrvA c vac 4AL,I. <br />I.IN TRAre <br />MADS11;1 (.V <br />S'DEVUlKn <br />MA4 CIKLe t.1P1X`^ tfF <br />a' •r� <br />— <br />MCf Tt HO <br />n1A <br />VSF 7n4C -� <br />NA <br />A <br />Zf <br />.JT <br />"C 41 LIt / <br />❑Yri /Q 4n <br />FEES <br />VALUATIGN <br />_ FEE <br />_ <br />ellnM . <br />ITIGNI IIVItAIgN <br />FUnIE <br />W O IIMIIMG <br />DIDS <br />NA <br />ell. M NMI, <br />MOIANlG --- <br />- <br />_ <br />OCI:ITAhrY <br />Y1 fA [I.vflS <br />IX:rIPAn1 MAD <br />BAN Yf 41 <br />-r"AMCAI <br />rnrlur <br />O.ls O l.n <br />AUDIMMAI MAn LIYr. <br />_ <br />nM stm4nLEn MOD <br />IN AS(N <br />OIu1n <br />pPC AtAMA PCn9 <br />MART' <br />qqf PIMDl4G SlW11ARGf <br />twFaroncl <br />nA4s movfn eY <br />CRY OF EVERETT <br />nIN A`. MtIPAs <br />-- <br />#�'L <br />R4 J <br />LOCAL SALES <br />-- <br />DAI -21 ,DI U <br />TAX CODE IS 3105 <br />TOTAL <br />