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APPLICATIO6 FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />NEATINO SYSTEM_ JOAS OELECTRIC U—_ _ ---J <br />BUILDING DEPARTMENT <br />259 8810 <br />I. i DEMOLITION COMBINATION I I BUILDING (MECHANICAL _ U PLUMBING <br />SIGN <br />I[NArR <br />SIRS. <br />cm <br />n ^� <br />ARCHIT[cTOtmSEWER <br />wtALMESS <br />Cm <br />SA' NKI.E <br />UKRAL ONtlW7011 <br />wIARO S <br />cRY <br />!/ MICME 6tAiF l4EMnE• <br />STAR <br />CONTMLI MICE rx vuwt• <br />UFYaIBF WfIM1I ALmnWIM rWibE NVQVEU <br />CCNIACi aFR�aN0 a1VYlE 1q ny�� <br />Ef_ �JN �CC�7 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />Movos[O UnT v nw�9— <br />PROVISIONS <br />WORK PLETED WITH WHETR SPECIFIED ETO <br />LGRANTL BE TIINMG <br />AnACN Twoccortel <br />LEaLaxariwaMrnair l6EgMle[LONCR <br />NOT THE OF A PERMIT OES NOT PRESUME GIVREIN E <br />LOT-- xacx a <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />1 <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />1 AM AUTOR'ZED BY THE <br />PERFORMAOE OF CUNSTRUCTION THAT <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 W AND 298.200 WAC. <br />��jl /, <br />`'i — <br />P a EL Iu I P MWnfR <br />CONS1aUc141lOW lEM%a.4CNfSn. fFLf1'11G<MILRfa <br />PREAD <br />OJCT DR / rL • <br />, <br />uA•f%T%A <br />wn <br />cn•rnrn�r.w <br />Nn <br />PLUMBING <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />MECHANI­77PE <br />O' <br />OF CAL <br />P E� <br />FEE <br />WATER CLOSET (TOILET) <br />A'C A/NNOIG UNITS—M <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T U. <br />_ <br />LAVATORY (WASH BASIN( <br />UNIT HEATERS —BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK f DISP <br />VENTILATION FAN <br />DISHWASHER <br />S <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNINGI <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EYHAUST FAN <br />SINK ISERVICE—BAR, ETC.I <br />t <br />r <br />SUBTOTAL i <br />SUBTOTAL f <br />PERMIT f <br />PERMIT 4 <br />1:1 LFEE $I <br />TOTAL FEE f <br />FOR OFFIGO ui[C <br />FROM S[rnACA <br />MF[L Y: <br />aEARSEtR1Cx <br />nIXBEIBAGx <br />MNCHFCx 1AlAB[R <br />rF[ <br />RfcEvt No <br />BSE 2OiIf <br />LOT MFA <br />vACMIT Nit <br />YES f : O <br />FEES <br />VALUATION <br />FEE <br />BUILDrw <br />RUMBa1D <br />rmwLIYRT <br />No vntMrtn <br />tee..[. .a mt,-o n <br />Lw <br />MECHANICAL <br />MEEOr Y00 <br />{�MLLRSREOO <br />bAs[MENI <br />YES O <br />— <br />Ocr,InwNcrLOAO <br />rx1[MAIIYI afOO <br />NEgNI LANIAtKri <br />ADWTgNAL PLAN CNECN <br />OTHER <br />MASON <br />STATE Bl1AfNNG SURCHARGE <br />FUBLx: III' INExs <br />ATAx[nr PLANS AarrovEonr CITY OF EVERETT <br />LOCAL SALES <br />rrn TAX CODE IS 3105 <br />TOTAL <br />