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APPLICATION FOR CONSTRUCT& PERMIT <br />CITY OF EVERETT A BUILDING DIVISION <br />3200 CEDAR STREET A EVERETT. WA 98201 • (425) 257-8870 <br />I.1 DEMOLITION ❑ COMBINATION, J [ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />I�:il]q�NLU77i <br />(, 4*e)l 641-2719 7 <br />•nPErtcS OR ptLOn[N uu EMtpfss C." fx• IXIpM <br />SA wI e <br />OTwmcmlwlm NAX mM ss CHr M n•rA ATM(ICENVf <br />wwA`AC4cmmxtm VSR AO SS a" M ml MAN LCI%51. <br />bi"mcmikp TSXI VAA Alp[!! pn RP n10Nf SIATT ICENU. <br />CONIMCT TXKYMwpb <br />e u L(uA.f <br />HEATINOSYSTEM: OAS DIELECTRIC O <br />lClCblTpdb AM TdN (OOTApt NXdNFp <br />/LI�W t -E /aC cf <br />I;pRAtIrtPSONAM NU•p V7, Z 617- 72/ HAYAIt <br />L65 PF '[ti I Gql- 2 3 <br />/ <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANO 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 /IOLATE OR CANCEL THE PROVISION OF ANY <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 />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND /296 200 WAC <br />(�� —l1 AiC-s� JLI/ 47 <br />mposfa lKE M luXOilll I <br />INW Msc"'mMI(IOIiRTT Ib101TT1 MTOwW� `MIAGI tAot N <br />IOT ROpt pL I - <br />J pp <br />//DA9.7. •� •�7 Z9 ' DOZ -DDT- <br />„f <br />pp <br />A Res T pJ • T <br />IxRctt w IO MMIP <br />CONSTMtIIIN IRATI I TWA. MXIIt!! RtFRKnI MIAMI" <br />"ATUIE <br />of, llllb[!l tow T10 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />:f <br />WATER CLOSET (TOILET) <br />A/C —AMNDLO UNITS <br />2- <br />BATHTUB <br />FORCED AIR SYSTEMS <br />3 <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK E DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />( <br />CLOTIIESWASHER <br />WOOD STOVE <br />URPfQ <br />METAL FIREPLACE (WOOD BURNING) <br />URINXING FOUNTAIN <br />FIREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />DACKFLOW PREVENTERS <br />GAS RANGE <br />SINK(SERVICE — BAR. ETC.) <br />GAS PIPING <br />_ <br />EXHAUST FAN <br />I <br />_ <br />SUB TOTAL f 1 <br />SUIS TOTAL f <br />PERMIT f <br />i I <br />I PERMIT II <br />_ <br />TOTAL FEE $1 <br />i I <br />I TOTALFEE f <br />FOR OFFICE USE ONLY: <br />."YvtAYp 1 <br />RAR RTIHf.N / <br />14 Y1!!Gt <br />NWpS MNMR <br />(F <br />Aff N'T n0 <br />n <br />7 <br />uu roNf , <br />IpT.n'A <br />V cml Wt <br />fEES <br />VALUATION <br />FEE <br />llbllnfl <br />_ <br />7/� /7 <br />owrD M1 <br />NSXWTIxNISIgN1 <br />A�POp[llpll <br />bll mKIXVII <br />S� S <br />11 <br />MIAMIA~plJ�:jIN4:Y <br />pl (X fl�nlf <br />N. <br />(Ifc1I'AN11UN !If NI <br />yffxANf11 <br />--- <br />�tY_•1 <br />on! � <br />AppIXINb NAN pXCA <br />_ <br />1 nXS .Ifp R09 <br />MA5p1 <br />OTxfR <br />IXXYMN of Jp <br />Fp11 bnOMl mA -mK— <br />_-- <br />1 <br />I'M M roves <br />RAN%AH (IWOM <br />CttY OF EVERETT <br />nwr,R011As <br />2 -�-" <br />�� <br />9 t% <br />LOCAL SALES <br />TAX CODE IS 3105 <br />— <br />TOTAL <br />--- <br />n.It "7 <br />