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APPLICATIN FOR CONSTRUC&N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • (425) 257-8810 <br />O OEMOLRION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL W PLUMBING 0 SIGN <br />♦ ffLt ORRLYd(R Y.F YyYY15 G% 11 %(W <br />Gfw"cPlt11. lm YM.IX%!(s all 1" Al1VL PI.II IKrw. <br />wc..Y.. l(%IRKI(A VAh Ar"ss an M Prdt lr.IF Ictw. <br />lA�tlliGUS_t}1(ddnirn�Ln. 3903 5n i�111w _ EyrrrH 98261 (yt)�oB�Q WILL I mIo�PA <br />%IwFW CONrRKig1 Y44011s1 CI% 71 R(A1 s1.RISA4r <br />CUIHR.CI PIRLI O R <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />osxRler rr0wr ��a www roonol mv.TR <br />coRr.cr rtRwY.RR R.n� xo <br />rtKRnV D114 w w.tP1R1 <br />I HEREBY CERTIFY THAT 1 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 />PARK "IL 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 LOCK. LAW REGULATING CONSTAUCTON OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION 15 MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1027 RCW AND 296200 WAC p <br />��'QrLn��t s1��- Y-/F <br />tfwt OSCR11KM d FnOwRR IUVRY KIM W ATF"tv*!) ALH <br />tot am w <br />IKIICFI toro IAAMR <br />f-OYRtIRKRONIOIMHw1rA.OY1LRl RHFHb1L 1AlIMR <br />1 wlt <br />ut. w9wu tn1AL No <br />PLUYSINOI <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR OEM <br />FEE <br />No. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOIL ETI <br />AC -AAWLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASINI <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SUM({ DISP <br />CLOTHES DAYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNORY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACXFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE -BAR. ETC) <br />OAS PIPING <br />_ <br />_ <br />EXHAUSTFAN <br />SUB TOTAL f <br />SLID TOTAL f <br />PERMIT f <br />PERMIT II <br />TOTALFEE f <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />t MNt V'tR.f• <br />wmwlw. <br />MWISAL, <br />:)?CI <br />R I <br />Ht <br />wtt1r M6 <br />uu lvn <br />wIRHI1M1.�Rn <br />101 W A <br />wcwl VIE <br />Ortt 01A1 <br />FEES <br />VALUA110.11 <br />FEE <br />wMwA: <br />_ <br />—j— <br />wanwllPq <br />IRntP <br />f.eEvwoml <br />%IAWI <br />- <br />-_+ <br />pLU11.Ylr Y`n.ewn <br />O1CIR' <br />W(IfAN11U41 <br />F.YIRM1 <br />O•H O Yp <br />MnIAaR:Y _-_ <br />tl <br />— <br />ACOIR%4 RMCw C1 <br />-- - <br />�+ <br />flESrcn.•IINw�O <br />-- <br />w.V% <br />OIMR • <br />rtK Yl.Pu wuO <br />w.Hw <br />PIYI YN WIl PA[wMV <br />_} <br />IYn Mfp`nl <br />nRRR AI'ROHOF• <br />ERETT <br />CITY OF E:AL <br />LOCAL SALES <br />oAlt TAX CODE IS 0105 <br />nRA r. rrwY. <br />----- <br />TOTAL <br />-- <br />