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APPLICATIOrI FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • EUILDING DIVISION �/ <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOUTION f I COMBINATION f i BUILDING f�N1ECHANICAL � i PLUMBING I I SIGN <br />PROJECT ADDRESS <br />u�n sooness arv ��i� mro�+r <br />unn enanes5 rnv 7m ruoqe <br />11RCNRfCTORDESIGNFR M�II �Of1f1ES5 f.ItY liP 1'��ONF <br />PFNU/UI f./ONLfUrCtOfI �I�II �OPfiCtiS GIY IIP PiIONf St�iC IICFNSE � <br />MF.CN�NIC,AI CONfRAf10(1 MMl �DOPF55 GTY l�� PIIONF SI�iF I IClNSF � <br />� G� Z <br />PIUMBINOCONIH�f.IOP MAll�OURESS CIfY IIP PIIONE SL�tF:If.FNSE• <br />CONIR�CI I'81 .E 01' WOI1K <br />�In[7.�� <br />�FSCRIOF Y/ORK �NU SOU�RF FOOT�GF. INVOIVED <br />9S O SF /h,✓vrn_ r .� <br />C� 9S /S�fAT F� <br />Ht�T, <br />i Ec�i oescmrnor� a cnov� <br />�ot . eia:K <br />a� �*ucH rwo <br />P�RCELT�%ID NUMBER <br />CONSTRUGTION IO�N IFN�F.0. �DOfIF55. iFLEPNONE NUMPFP <br />PLUMBIN6 <br />NO. TYPE OF FlI(TURE OR ITEM <br />WATEF CLOSET (TOILET) <br />BATHTUB <br />LAVATORV�WASH BASIN) <br />SHOWER _ <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINHING FOUNTAIN <br />FL(lOR UHAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETC.) <br />SUB TOTAL E <br />PEFMIT S � <br />TOTALFEE S ; <br />FOR OFFICE USE ONLY: <br />fPONiSFTP�f.N �E�� SFTP�CN <br />❑5F20NF lOt�nF� <br />PF�f.MTUMIUiION NOINbWILIINfi <br />IINII� <br />GCCIIP�NCv NO N SIOPif 5 (%-CUIMNI 10�1) <br />GIIOUP <br />IrtIf�U��PFOP flf�tiON <br />T. <br />HEATING SYSTEM: �GAS � I ELECTRIC I 1 <br />GONI�CI Pf RSON �Np PII(H1F NO <br />I NEREBV CERTIFV THAT I HAVE READ AiID EXAMINED THIS <br />APPLICATION �ND KNOW THE SAME TO BE TRUE AND CORFlECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL �E COMPLIED WI?H WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NUT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OP CANCEL THE PROVISION OF ANV <br />OTHEF STATE OR LOCAL LAW RE6ULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM ?HE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 iiCW AND 296.200 WAC. <br />X �� 8-/8 - 9S <br />SIfiN�lUf1E O�IE <br />f.ItYAUSMESSIICENSC N� <br />MECNANICAL <br />Np, � TYPE OF EOUIPMENT FEE <br />A/C — A/HNDL� UNRS — H P �: <br />/ FORCED AIR SYSTEMS — O.T.Uj'OM E.A. _ i <br />UNIT HEATERS — B.T.U. M <br />CLOTHESDRVEHS <br />VENTILATION FAN <br />RANG[HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACEINSERTIWOOD <br />GAS FIFEPLAC <br />GASRANGE <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAI. S <br />PERMIT S <br />iOTALFEE 5 <br />SIDESFTP��M PIANGIft Ny�fP /) fff RFCFIPiNO <br />/ FEES/ VALUATION FEE <br />V�C�r11511F ____—_— _--- — T <br />__— ___._—. i <br />I IVF$ � NII p1111PING 1 <br />Sllf 0� PIIMrtI —��— —'— — —_—�—"" � —_ � <br />1`I I INOINf} ' <br />—� <br />_"_ - I <br />P�SfMFNI MfO1�NIC�I. i <br />il�FS iiNO ___—_____ '._--'— — _ <br />- ----- nf�b�liONM PI�NGIff.K � <br />"_—" ' _'_ —__ �__. <br />onrtn '-- — <br />r�nnron r+r.��,.. <br />vni � nun owa sunr.�uncr <br />-- --� ---�- --.—_. <br />--- ' <br />st ri nas �rrnovm ev CITY OF EVERETT rnni �r wnnKc � <br />LOCAL SALES — ----� -- � � <br />_ --- — <br />„a,� TAX CODE IS 9t05 TOTnL . _ . . . L _ - <br />