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APPLICATA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 ! (425) 257-8810 <br />❑ b. 'EOLITION ❑ COMBINATION ET BUILDING <br />❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />q--9 / / 2,'-6 151vqr' <br />S�. <br />PRW ? ADDRESS ___ <br />tKYrw YNA •ooAt!! on <br />Tr rylDrli <br />1FM•Nr YM YER 15 Grt <br />!li wi1MF <br />•IICMnCr X1KN !S Clry <br />/I 1'M1Nf <br />— <br />—!St•1111tl <br />rtM[� rl LION NYNM SS �� 41 <br />l MtIl l� <br />YiCNWC4 tY1YN1Y:tOP 1•YI •GNYSS nn <br />�— lydF arri lCfMF• <br />FIIWgCWrllYapll YM YY![ES CIM1 <br />lY PMYR STAFF MTN9• <br />0pM11 H.c[ YO1Y <br />�7 /lA5 <br />HEATING SYSTEM: ❑ OAS ❑ ELECTRIC ❑ <br />ascot •Yt Y111•AI tl0r MIGY[O <br />CtWr•f.r Fr ASON YKI FINFVI ND <br />!7L/2- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW 111E SAME TO BE TRUE AND CONFECT ALL <br />111pNORolraF rt DIrO <br />PFOVISIONS OF LAWS AND OFDINANOES GOVERNING THIS TYPE OF <br />WORK PAIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />LFOAL DLICPIPrgl a mneKn lFrtl'/YAF1. mACN R <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />LDr k0m, M <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 FRFORM THE WORK FOR WHICH <br />APPLICAOR MADE I COMPLY WITH THE STATE <br />CO GTO lAW IB AND 254200 WAC <br />MIICFI IYID MI!!lR <br />li�c a ��� <br />COMlAIICRDYILYNI[rOA•RVRn KI[IYIPA MIMMR <br />! 4ar1 <br />CNt p19Ha! ISSN4 MO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIKTUAE OR REM <br />FEE <br />NO. <br />TYPE OF EOLNPA mr <br />FEE <br />WATER CLOSET (TOILET) <br />NC — A41NDL0 UNITS <br />- <br />BATNTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />_ <br />SHOVER <br />UNIT HEATERS <br />KITCHEN SIMI A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE IWOOD BURNING) <br />p11NKIN0 FOUNTAIN <br />I <br />FIREPLACE NlSER7 (WOOD BURNING) <br />FLOOR DRAIN <br />I <br />GAS FIREPUCE <br />_ <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />OAS PIPING <br />EXHAUST FAN <br />I <br />SUB TOTAL S <br />_TOTAL S <br />PERMIT S <br />PERMIT ! <br />TOTAL FEE S <br />1 <br />__ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />-- <br />rPfMlarllM'#_,�/ <br />RNNr)KN/ <br />Plli lfrYCy� <br />RwCIC! 11 <br />riF /I//0 <br />MnF'r N0 <br />II9110M <br />ION ANF• <br />V•CANr III[ <br />FIXVAIUA <br />ION <br />-� <br />Oai! OMI <br />YKDNN <br />Ni N1H11 WIMr / <br />M,13i(IYrlLN1R <br />IYFP KD6'II <br />) <br />�___ <br />10L S <br />MLN•MfY <br />�__ <br />UL1.111'•4♦ 4ia�i r <br />K 3 <br />U:fIN•Mr 10•U !•YYFN <br />Oat! <br />� <br />•fIdIRW4 RlN CrIF• <br />riPI S1Yr/tIFRKF09 <br />IR•!OI <br />NP <br />rFKYA1MNC'D <br />wum <br />YH A�•I WtNIrIfN•IIfR <br />ISLY <br />YFi rx Gsllr <br />n•N!•PIYKNrnea <br />CRY OF EVERETT <br />J_�_j <br />LOCAL SALES <br />_ <br />wrl 149 <br />TAX CODE IS 3105 <br />TOTAL <br />-� <br />