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APPLICATI& FOR CONSTRUC&N PERMITOL <br />CITY OF EVERETT •BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />CK DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: A/Lf <br />s <br />Irwxr uq Y ss (JIY )m <br />IJC 70 aI rx F . ....dp{%% Cln /m <br />'2 9 <br />MRM c411 UCrx51 1 ----- <br />fil"INOCa11PACIM V.1/.gN[55 drY TIP rxplt 5111r 11C[NV. <br />CONIPACrMM;[ U wCnll <br />_ <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />ascdtlE wnlm.Nnsw.nr rdprw[ Mvdvro <br />coNHc1 M nsPN.Nn n.rwr NG <br />Dry l4c^ 4 n Da <br />rnKONo V5[ a mmdNn <br />t[Gm ascdruwa[Nror[PnISPOlw enowop Anwxlrm ca+[m <br />IG1 Hax a <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 10 BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK W11L 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 PROVISION OF ANY <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 I W IP 27 RCW AND 296 2DO WAC <br />, <br />X <br />rAma VA..o MIUNn <br />.✓9/ 7(nLo O/5 Da� <br />c rKMlwxlrNaP uxwrss Ttt[1NgNFxwpFn <br />VPl - nm <br />C." N1 w Ss I ICI NS[ ND <br />MECHANICAL <br />►LUMeINa <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />iVPE OF EOUIPMEHT <br />FEE <br />WATER CLOSET (TOILET) <br />AYC—NHNDLG UNITS <br />--�— <br />BATHTUB <br />_ <br />FORCED XIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />1VATER HEATER <br />CLOTHES WASHER <br />WOOD -STOVE <br />�— <br />URINAL <br />METAL FIREPLACE BY00p BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR, ETC I <br />GAS PIPING <br />EXHAUST FAN <br />SUBTOTAL f <br />_ <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE $ <br />TOTAL FEE f <br />FUN UFFICE USE ONLY: <br />rMyl ylp.C. <br />Irc.p srleA[R <br />Sla srle.c.. <br />n.x dltr11 NU4Eti� <br />nr <br />MCrml No <br />usFrmF <br />1o1 AP[A <br />vwAN1 NIL <br />OYES a. <br />FEES <br />VALUATION <br />FEE <br />eul dNr. <br />—�— <br />xFInxIRMMIgN <br />4o aPWrtSMn <br />IMIii <br />WEa e1W11 <br />.— <br />nIIV111Nfr <br />aX�1NCY <br />YGn51M.5 <br />a:r10.Ml lOw <br />e.V 4t N1 <br />OYES O No <br />MtI—+-- <br />- <br />AM9PN I n.N dMC. <br />-- <br />IYNYYP mmtt.Kll <br />Pr A5a1 <br />oL4p <br />51.1f AlYInMG5lW.Anr4 <br />IYM or Ca l <br />nANs.r1NOYFne, CITY OF EVERETT <br />LOCAL—�— <br />oME TAX CODE IS 3105 <br />nml K.wdms <br />TOTAL <br />) <br />