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APPLICATIA FOR CONSTRUCAN PERMIT <br />CITY OF EVERETT r BUILDING DIVISION <br />3200 CEDAR STREET t EVERETT, WA 98201 r (425) 257-8810 00L <br />I I DEMOLITION ❑ COMBINATION ❑ BUILDING 19 MECHANICAL ❑ ILUM91NO ❑ SIGN <br />PROJECT ADDRESS:y_ <br />♦"'Tc, pR RlTbiP u"r ss t11r m 1'.Uri <br />1'rvvT N P.ci•c"t-n <br />CONING, IYIICE w tYwM <br />HEATING SYSTEM: NIGAS ❑ ELECTRIC ❑ /9-I <br />a[xCRM NVIn xMI SOUAM raOIAOF MYOI o <br />CON•1Cr n Psm AIM M w <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION F L WS A THE SAME C DE TRUEANDCORRECT ALL <br />WORK IONS OF LAWS AND ORDINANCES GOVERNING D H TYPE OF <br />WORK WIIL BE COMPLIED WIiN 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 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 I COMPLY WITH THE STATE <br />CONTRACTORS 1 A��Wt, 10 227 <br />]] RCW AND 2N 200 WACy`� <br />A. /�]/yS.Y / �y7 <br />pl. M MMOPu <br />`J <br />/L <br />t[aa PtulxPixX,a PwwKM1 HMMN PrtO1Y U1 ATIAp tMOCO1KFI <br />tot etoa oI <br />Iwc[t w I a NIAIt[K <br />FANSTMK:tKM IOW IIAIRA. NKKI[M IEl[M4K NIAK[P <br />trYUllxK wR <br />�T <br />GiY MAIIRss IC[NSL MO <br />PLUMBING <br />MECHANICAL _ <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EMIIPMOFT <br />FEE <br />WATER CLOSET (TOILET) <br />AC—ANNDLO 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 />, <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKNG FOUNTAIN <br />FIREPLACE INSERT WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />I <br />BACKFLOW PREVENTERS <br />GAS RAN13F <br />SINK (SERVICE — BAR, ETC) <br />OAS PIPING <br />EXHAUSTFAN <br />I <br />I <br />T <br />SUB TOTAL ! <br />SUB TOTAL! <br />PERMIT S <br />, <br />PERMIT S <br />TOTAL FEE IT <br />TOTAL fEE ! <br />FOR OFFICE USE ONLY: <br />IMM11 YrxYx <br />M1P NIetC11 <br />LaC M1eICx <br />RWCIKCx M1tMx <br />Pit laW <br />IaI YRx <br />YKWI Lis <br />F EB <br />�� <br />D YIt OIU <br />IKroNi I•wi�rNw <br />Na aMwttPKl <br />xuea R06P1 <br />IIMIP <br />nI1NIMa <br />pct;IT1Y,• rnnluwl <br />�POIF <br />UC.CIN'WIIWP <br />txYYENI <br />MCl1xMf.M .___._ <br />Gtft GNa <br />IF[siwiMl[P PCOD <br />PIxMYt <br />xaplgN4 nW Mtl <br />a1HIK <br />rIAE AINM PEan <br />M APm <br />xixlf MnaMl L1111:WP(H <br />ttRnrbNxr <br />nANSAmlmtae• <br />CITYOFEVERETT <br />nKl r. Na.s <br />LOCAL SALES <br />------ <br />,,... <br />TAX CODE 15 3105 <br />TOTAL <br />,IF <br />