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APPLICATICf FOR CONSTRUCION PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT, INA 98201 A259-BB10 <br />t4 sRLffr��cl� <br />III DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICALF ❑ PLUMBING ❑ SIG] <br />PROJECT ADDRESS: /S/S -S.W. ?5*1 Esc. i4lir"T? Iw»TwAc ruit+n) <br />VNNkN Ytl WI'M\1 Y'' PI. (T INp,{ <br />L PIS 15'35 0- 4-e S. S4 'D' 4A[9R lzoi�)5-83-Po3-0 <br />O[MNY CONIPIfibl Y4ADOPE&t C.n 'A' MKA4 0I09LICIAM. <br />5.6+ A . 6:414 ZOO" Sr. S.W, <m Zm LTi-AAA.E., ..d 41&13G AFs.1 77A-ZIAI <br />CONIMCI PPCtp WORA C° <br />2 4a <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />OEN]SB[INyV AW[OI[AR[ IMIAOE PI VED <br />_ <br />CONIACI nPCoP AAA) PMN[ No <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI; <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALI <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE Of <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVI <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANI <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THI <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THI <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICI <br />APPLICATION IS MADE AND I COMPLY WITH THE STAIR <br />CONTRACTORS LAW 18.27 RCW AND 296 200 WAC. <br />- <br />`y (�,/ /�(- /J�—^' • 17 - 1 —11 <br />PAoroffo USE OF ll A <br />.awrrlwpProrKPn IN[oPN e[Lowam.cR MO Conpl <br />LOT wow p <br />PARcfI ru m. rul.eEP <br />O <br />CONstP TADA1 LOAF LENCIP. AOORfp. IlLff I N NIP <br />{INMn1IPf ' wlE <br />on euWKEE LCENu w <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AAOBILG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR GRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR, ETC.) <br />GAS PIPING <br />EXHAUST FAN <br />L, <br />r <br />SUBTOTAL f <br />SUBTOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE IF <br />_ <br />TOTAL FEE IF <br />FOR OFFICE USE ONLY: <br />I ATUTBACA <br />PC" 5FISACA <br />Sim51rSACA <br />mmcMcAP,AwrP <br />III <br />PIr(WIW <br />r <br />us[IovE <br />to, AMA <br />vAC., W[ <br />FEES <br />VALUATION <br />FEE <br />OIRIPMI <br />OTIC DNO <br />'I,1lPP1A1gN <br />Cut Ul woo/11 <br />mpOW(IIIW <br />IMIP <br />MIPIAM <br />a rMANCI 'OnfIMN <br />OCCWANI IOAO <br />NAw AI[NI <br />Y[CNAMC4 <br />Drts OPO <br />AOrAIIONAI WAN tNrw <br />rME NFNP,IIG P[oo <br />MANON <br />o' KR <br />FgENNWREov <br />PI AfiO. <br />MAI(B4loM0 NRKNAP[H <br />nnpCpnr <br />WANE APPRovm e. <br />CITY OF EVERETT <br />MNII r.vglnR <br />LOCAL SALES <br />—1 <br />TOTAL <br />t <br />TAR CODE 15 0105 <br />out <br />