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APPLICATI6% FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT ! BUILDING DIVISION <br />7200 CEDAR STREET K EVERETT. WA 98201 a (425) 257.8810 <br />❑ DEMOLITION ❑ COMBINATION �1 ❑ BUILDING (MECHANICAL ❑ PLUMBING D SIGN <br />PROJECT ADDRESS:�O(_ 5 %rr/ATQ .54 e!-6� ..SL <br />�esse Pono 'S.n•P��x n SI S£ �G 9A&r�A � �/�.�• 353- 9'VS4 <br />o2ti+ <br />ItwNl Yq •rldfM mr PNda <br />.ncl.rtcl oPdt,.KP,P1P- N•K •dnx an 1mFjyt� rNM <br />��[N➢P�IE[1G�;aw �ILI6 P,oEtpll'nul�gOrAUZJ__' 9-y9/Y��,o���el� <br />dw a urvm.cirn q •--il wps! �^ cnr pr nPrw PI•N xrNv f <br />YiCIIINIC4 flWIPKIUP Y.f •19PF!! ryn 1P' n.Yt ll•rl lC[NHI <br />nlWehnfMlPlClp YN•dgN CITY !n nl(Y11 61.1E IICt4A1 <br />ILL <br />CONrP.GI Pn[I d YIffM <br />_ <br />HEATING SYSTEM: CI GAS ❑ ELECTRIC O <br />�SCMef InWPllOd.d Mr"` C 4e r, <br />npl.Cr rl Pldf•M nNM NO <br />HKinofrolw d mhoPn <br />un•faxwnrldld rmRAn ILPJYNI RIDN w.n•cN *Nocaxu <br />loi sncP d <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT 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 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 />APPLICATI IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRA W1027 RCW M200 AC <br />P•IICfI Inm YIYRP <br />c4iYes, cmNlowlrina •Ilf•It{A RI[ngNE IAANP <br />- <br />It n•II <br />CITYfUgNtff 1ttNY NO <br />PLUMBING <br />MECHANRAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />I TYPE OF EOUIPMoff <br />FEE <br />WATER CLOSET (TOILET( <br />AM -MBpLO UNITS <br />BATHTUB <br />I <br />I FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />I <br />HEAT PUMP <br />SHOWER <br />I <br />UNIT HEATERS <br />KITCHEN SINK 6 DIfiP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HFATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPICE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />OAF -FIREPLACE <br />BACKFLOW PREVENTERS <br />( <br />GAS RANGE <br />SINK (SERVICE - BAR. ETC) <br />GAS PIPING <br />EXHAUSTFAN <br />_ <br />SUB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />I <br />PERMIT 5 <br />TOTAL FEE E <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />IRWIYIPMK <br />R•R trle•CK <br />lqL f[rYCP <br />nIIN CIjCP P� <br />!f! <br />RRP'f Nn <br />Ulf!/d1f <br />RKwUwr•rPn <br />APAM K.r Ylnru'�H <br />(I <br />tigamrnllPMpn.—_ <br />IMF I.I•IM PfVn <br />rrn rK rPNar <br />1( YK. <br />MANY wit <br />one D w <br />FEES <br />VALUATION <br />EE <br />J <br />- <br />—i---- <br />MNr.K <br />- <br />YY d IMIHPq <br />IINNc <br />eut d woonl <br />hINwN(I <br />..��_ <br />UI M1N4NIIU•U <br />Falf 1KN' <br />Onf pYn� <br />g1:N•M4 <br />•ndIKIN.I n•NMCP <br />R•tIF <br />_ <br />OINtP <br />R.s(yr <br />fl•11 MMIIMNI eIPKN.II(11 <br />n..f mlrolrner <br />dq <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE 153105 <br />��IIr NIp•a <br />-- -- <br />TOTAL <br />-- <br />