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APPLICA70H FOR CONSTRU*ION PERMIT <br /> CITY OF EVERETT A BUILDING DIVISION <br /> 3200 CEDAR STREET F EVERETT,WA 98201 •257.8010 <br /> I-1 DEMOLITION I COMBINATION ❑ BUILDING 11 MECHANICAL II PLUMBING II SIGN <br /> I PROJECT ADDRESS / <br /> ( A Y4 AppK5E GRY In IINMh <br /> M4LAOp<Sa Gry In <br /> Plpt <br /> APCWTECT OR WILOIER M•EAIX n GM1 —le PIOIE <br /> I/ � `/ <br /> G CCMTMCi YAILAXIFIESE GTY In �AII LKfM/5Fj•(//,1O� <br /> YECN•MLK CpRPACIpR MM AClPF6E GT, --lA` —?ten <br /> TI I��`//L� <br /> PIFy< 6E.CFIFEE• <br /> KUMIMOCONTNACTpq MM AppNEEE Gli Ix ggryF 6l•fE IK[MFF <br /> Cp WT MICE OF Y.VIMI <br /> HEATING SYSTEM: ❑ LAS O ELECTRIC O <br /> pESCREE KrdM AIO SOUM[fOOTAOE MYOInp LONTACI HPSpI ANO PKpNF NO <br /> S� <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPoxoIIEF a SIROJAI n APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEOAL OEecnrTKNa vRDA[Rry IS1101M Faava ATTAa TRomPEt WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOTKpCN- .OE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TIIE <br /> PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> G APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PMC[[Tu lM NUNE11 CON�rr�RCW ND 296.200 WAC. <br /> Cd1STIKFCiKJNIOMIIENOE0.ApTnESS.TEIFMKNF NUMSIR 6 Q �/�rYiJ <br /> CITVSU6n SAMNSEW <br /> PLUMBING _ MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) �T NC-NHNDLG UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) ) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK A DIS P OOTHES DRYERS <br /> DISHWASHER RAN,,,F ry000 <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER _ WOOD STOVE <br /> URINAL METAL FIREPUCE MOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT BYOOD OURNINGI <br /> FLOOR DRAIN OAS FIREPLACE <br /> BACKFLOW PREVENTERS GAS RANGE <br /> SINK(SERVICE-BAR.ETC.) GAS PIPING <br /> EXHAUSTFAN ,I <br /> SUBTOTAL S SUB TOTAL f <br /> PERMIT S PERMIT f <br /> TOTAL FEE f TOTAL FEE f <br /> FOR OFFICE USE ONLY: C <br /> FFIONS/'3/h) <br /> T SETSAFK EISAq KM F <br /> SM / / �E[1M9t KM PECK MW KR FEE FKCEIPTNO <br /> UEE1 /F ILTMEA s� 14 <br /> G VCMF� MOM <br /> FEES VALUATION FEE <br /> ant am <br /> N[KMFTLANTATwn waunum MOF KIYMTI SIJ <br /> FA E <br /> (o OSS nulwFa <br /> Y 100 STOAES CCCWAMT l0A0 IYESUEM <br /> / YECMAMIGL - <br /> Z one dTO <br /> FME6 MN[A REOp REASON AOpIKNµKAN CHECK <br /> FMC AIAIIM N000 NFASIXI OIKEII <br /> STATE SUILOW CNAROE <br /> TmEacwET KMs•PKn.EO Kr CITY OF EVERETT Fuwc RTJISTS <br /> LOCALSALES <br /> DATE J113420 TAX CODE IS 0108 TOTAL <br />