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APPLICATItil FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT • WILDING DMSION <br />3M CEDAR STREET • EVERETT, WA 9=1.2"10 <br />SNw <br />❑ DEMOLITION ❑ COMIMNATION El iUaJgw o , ❑ MECHANICAL ❑ � ❑ <br />cwlwpl HPa a wnlw� J J - <br />HEATING SYSTEM: OAS ❑ ELECTRIC ❑ <br />aSaMFPa111.NOSQMPFipp iP IXVEO <br />CwT R/n1SaItM M a <br />MI 4 Ulm III <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND ODRRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PF0VNWN OF ANY <br />OTHER STATE OR LOCK LAW REGULATING OONBTRLICTgM OR THE <br />PEiFORMANCE OF CONSTRICTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />AC �TTION IS MADE AND I COMPLY WITH THE STATE <br />CONT RB LAW 27RCW MID 2M100 WAC. <br />X <br />uN a wAAPD <br />ItouascnPrgP w n wn IaIDPn Mta M AnTwo cvi s. <br />1 r, 3 wmK a1 <br />L TM I D MII•RFP <br />WR6 CRa 1 Y11iMrtP NIIIIl55 RIfTYNF MILRR <br />ARAM wn <br />lY p1YNF551SEN5E PO <br />PLUMPING <br />MECNAMCAL _ <br />NO. <br />TYFE OF RXTIIIIE ON REM <br />FEE <br />NO. <br />TM OF FAIRFMMIT <br />FEE <br />WATER CLOSET (TOILET) <br />AC -Meato UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />J <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 />LAUNDIIY TRAV <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE WOOD BURNINGI <br />-FIREPLACE <br />_ ± <br />DRINKING FOUNTAIN <br />NSCi1T (WOOD BURNXXl) <br />FLOOR DRAIN <br />OAS RREPIACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE - BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT f <br />PFRMIT f <br />_ <br />TOTAL FEE f <br />TOTAL FEE f <br />- <br />FOR OFFICE USE ONLY: <br />7"1 IIP.fR <br />WA.R. lft iI <br />$la 5{I!•LII <br />rI I.M fIPfItMMER EI{ <br />� <br />Plall'1 N0 <br />2©' <br />20' <br />s' <br />5773 <br />us{rw( p- <br />lol note <br />veuMl9R <br />FEE6 <br />VALUATION <br />FEE <br />PIe,D.IR1,5, <br />;; <br />;oo <br />f <br />/4DGo b_ <br />ITrIS <br />MEIGIII I�MNAIPIT <br />�](j <br />ND a1MTLIRK <br />VMllt <br />C�}EaNM/11 <br />' <br />O �� <br />r11 MPNO <br />� <br />LL I <br />3r <br />D W-K`lI (•s'—s <br />OCC111'.HI IO•D <br />IeSELFMI / <br />WC"M K;A.I <br />Ir32 <br />❑v!i �n <br />4'iRIP1N.1 H •N L:NC• <br />(IRF SrPiRRIER RCO'D <br />Rf •SM <br />- <br />DIIItR <br />IIRC NANM PEOD <br />a ASM <br />4'J� <br />l <br />SIAI( PIRIDINR G11Y.NAMt <br />-:0 <br />IRYaCORSr <br />M.s.R tvftle <br />CITYOFEVERETT <br />rlwi r. Pvxwi <br />_ 1— <br />�- -N <br />DAr <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />- <br />