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APPLICAT& FOR CONSTRUCON PEC:MIT <br />CITY OF EVERETT q <br />BUILDING DIVISION <br />0200 CEDAR STREET A EVERETT, WA 98201 q (425) 257-BO10 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT ADDRESS: RA S SE <br />E <br />s <br />IV Ilt� M`( f11E1� 2b �� r sE <br />ELIF_REr�4S 974-c <br />ONrgq YW ! On <br />M nW <br />IIM•Mr YM Y4A51 FJn <br />)r `wAF <br />YIdfRGI Cq OLY0r1IR Y•11 •!nq{SS Ci11 <br />/n' 1'r9yr <br />OF4Ln4 CdIN[IOI 4M MIIA SS MS <br />!iC w.Ml SI•IS IKFNV r <br />YrpYt4 CdAA[IfA My •HOLM f4 nn <br />l•' wqA SIAII ISFMFIr <br />M1IAYMIOCdIRvip1 Y4l AlOAf) Cn <br />M w1Orq PAR IKFNSIA <br />CON`gA" IAA" °r "OPq <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />prxYYFr SYpgf SNp f01YM rOOIW NSAV[O <br />CONI•KI NIISON u11 M4i MO <br />K 7-` <br />0K — >gn <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />Lupt4Dgjr goo \A <br />APPLICATION AND KNOW THE SAME TORE TRUE AND CORPECT ALL <br />ouu A FnRMO <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />Ir/W AxImIKMaPIlOAAn IfWXM1 MLdtw •nKN AO COAR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO OWE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />IOI AIOCA d <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 />2 2APPLICATION <br />15 MADE AND I COMPLY WITH THE STATE <br />- <br />CONTRACTORS RAW 18 TT RCW AND ZSA 200 WAC <br />l+gcn wlo lgAllYq <br />CpNSn116rpN10IMHMRK APINFFf m(nIO11AARFK <br />1�-� 3 pp <br />A <br />F <br />S MK PAIR <br />an fVl.xlAf lnNu No <br />� <br />Rp <br />MECNAMCAL _ <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />N0. <br />TYPE OF [OIBrMBR <br />FEE <br />WATER CLOSET (TOILET <br />MC — AM/DLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />lf ITORY (WASH BASIN) <br />HEAT PUMP <br />1 <br />SHL/WER <br />UNIT HEATERS <br />y' _ <br />_ <br />KITCHEN SIML A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL - <br />METAL FIREPLACE (WOOD BLKINING) <br />DRINKING FOUNTAIN <br />RREPLACE INSERT WOOOBIMNINGI <br />FLOOR DRAIN <br />LIAS FIREPLACE <br />1 <br />BACKFLOW PREVENTERS <br />OAS RANGE <br />—T <br />SINK (SERVICE — BAR. ETC) <br />GAS PIPING <br />77 <br />EXHAUSTFAN <br />1 <br />SUBTOTAL E <br />1 <br />Sl1B TOTAL f <br />PERMIT f <br />1 <br />PERMIT It <br />TOTAL FEE ! <br />TOTAL FEE f <br />1 <br />20 <br />FOR OFFICE USE ONLY: <br />IIIIMIVAM <br />AAPA1FIi. <br />MIIF YIYC• <br />M1WCA AIEI� <br />IF50 <br />fr.'I NO <br />Zv <br />LMFdY <br />IMLA• <br />YK•MrYll <br />FELA <br />VALUA ION <br />FEE <br />c00 CJ Y- <br />ortf 1FNP <br />gwlKNr. <br />:% <br />Nr1ON11M1•IKM <br />O OgIlIMO <br />fMl or Kagni <br />IAc <br />"INNCI rO nfll'M5 <br />PLIgMN110.O <br />F YIgN1 <br />yrfMAYf4 <br />R/ <br />N/9 <br />___ <br />I <br />111t IF1 Mr1D <br />A•lfM <br />FpP11IMY nW CAC. <br />—+ _ <br />OIAn <br />rnr AlAw Aoo <br />_ <br />A•AM <br />S 1.1l A1gnMiS,AK4•nM <br />4l_'}L:f1 <br />nMKrK1M+ <br />_. <br />Vl_ <br />IIW CIA M, l <br />nANl ArNwoYlnf <br />CRY CF kYERETT <br />LOCAL SALES <br />— <br />—_ <br />11. Aj <br />TAX CODE IS 3105 <br />TOTAL <br />,�L- WINE <br />