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APPLICATION FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 . (425) 257.8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDWO QS.MECHANICAL ❑ PLUMBING ❑ SIGN <br />PROJECT <br />II ADDRESS: <br />i <br />ARCHRCI prpyprlFR 444MMt14 CiM1 !N' nrgr/ <br />AIMMICORIRY:Ig1 4.4 Yf0116S Clh !In nMNr Snq 11CfM51r <br />cd�Ha Er rRICF v npl� <br />HEATING SYSTEM: AOA8 ❑ELECTRIC ❑ <br />u ANO oorAOr vro <br />401. gar <br />cn.n.crnwso4.rnnRr4AIo s <br />, <br />1 <br />_ <br />1 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 REGULATINO 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 />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 11127 PCW AND M 200 WAC p ry <br />K } ` 9 -�6 - / A <br />WorouOOu a mnonln <br />LEGAL MURFlKM Or nGOPLRn IM.TIYrl anoRaRAnACR TRpcaxu <br />1Gf RpcLI__p_ <br />F'AIItt1 OM In M R <br />cannKlcfKw LOW I[.GfR..PIRtf RlfrfOM[MMRR <br />_ <br />S.WAtIKA G.II <br />nnfMwauLnRu Ro <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EGUIPMDfT <br />FEE <br />WATER CLOSET (TOILET) <br />NC—WHNOLO UNITS <br />BATHTUB <br />,:L <br />FORCE D AIR SYSTE MS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP _ <br />I <br />SHOWE'1 <br />UNIT HEATERS <br />_ <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 />URINAL <br />METAL FIREPLACE WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE — BAR. ETC.) <br />I <br />GAS PIPIND <br />EKHAUSTFAN <br />I <br />SUB TOTAL S <br />SUBTOTAL S <br />PERMIT E <br />PERMIT S <br />TOTAL FEE 3 <br />TOTAL FEE S <br />FOR OFFICE USE ONLY. <br />r lKt4r vrRV. <br />KwuIYACR <br />mulw. <br />nw CBP <br />IIf <br />IffrA r.p <br />r <br />/ <br />ua rtnr <br />IOIwi <br />V-14r Wf <br />E <br />VALUATION <br />FEE <br />NAIbA1 <br />OK{ OIq <br />Nf KWILRATArKw <br />RO1A mums <br />AVf d RGG'TI <br />- <br />uR1 <br />nIANQ <br />OCR.' w, Ion If frM11 <br />ORdI� <br />GCCIIWRI IGW <br />A.rFN4r <br />W.A <br />Drf! GYI <br />— <br />M,fdM Nw MQ <br />rIRF SPRIMI[P P[09 <br />Rf.MM <br />Or4fR <br />rIM RRFGR <br />M.Wn <br />{r.rf MMUMI HKII.M4 <br />TV" (TV fOMir <br />MARS AnfIGYFOOV <br />CRY OF EVERETT <br />nwi r. RGR.A <br />SALES <br />LOCAL SALES <br />- <br />--�— <br />TA%CODE153105 <br />TOTAL <br />wrt <br />