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APPLICATIGrV FOR CO�ISTRUCTION PERMIT <br />�lTY pF EVCf1CTT • DUILDIIJG DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8010 <br />�DEMOLITION ❑ COMBINATION ❑ BUILC�ING ❑ MECHANICAL ❑ pLUMBING ❑ SIGN <br />PROJECT ADDRFSS: /„� � 7 -tzti � � r.> 1.� i n. I 4 <br />TCNNIf MAILAOb(IE55 CIIY )I� PHONE <br />�� <br />�HCMICCTO{IDESIGNER MFII�OUt1E5S ��ry yi���� �����,� - <br />OENFIUILONIfuGi0f1 M�II�ObI1E55 GIY )II` � PIIOIII! $IMELICCNSE� <br />�ECNANIC�LCONTR�CIOfI M�II�ODIiE55 CIIV �1I` PIIONE STpEUCENSE� <br />PLUMBINCCONfBA�fp1 M�IUWOE55 (;t1Y LP � 19q11E ST�IELILENSE/ <br />OE^uCPoBE MOIIK �ND W JFPE lOOIApE INVOlVEO <br />IEUAL OESCNPf10N OF %ip1'Epry �SNOWN BELOW 0{I A1111C111 Wf.� C WIES� <br />LOT BLJCN OF . <br />��`"`� Z.O-OOci -pp�-b2'C�` <br />CONSIIi11GTI0N 10�V! LENOEfi. �DpiE55, IELEAIONE NUMBEII <br />PLUM81N6 <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />WATER CIOSET (TOILET) <br />BATH7UB <br />IAVP.fORY (WASH BASIN) <br />SHOWEH <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUN�RYTRAY <br />CLOTHES WASHER <br />URINAL <br />DP!NKIN(3 FOUNiAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. E7 <br />I SUB TOTAL S � <br />� PERMIT S <br />TOTAL FEE f <br />FOR OFFICE USE ONLY: <br />lRONT SEIBALR PE�II SEIfl�CK S�OE SEiBSCN <br />USE IONE LOI ME� V�CANI SII[ <br />❑YES ❑ NO <br />NEIOIITLIMIT�T1011 NOOFOWELLINO 511EOiOl06/fI <br />lIN1IG <br />OCCUP�NILO�D <br />11E0'0 <br />OYES ❑ NO <br />IIEATING SYSIEM: ❑ GAS ❑ ELECTRIC ❑ <br />roeaer.r ru�c�n nnn rr�oNe No <br />I H[REUY CEHTIFY THAT I HAVE HEAD AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE Of <br />WORK WILL BE COMPLIED WITH WIIETHER SPECIFIED HEREIN OR <br />NOT. T11E ORANTINO OF A PEHMIT DOES NOT PRESIIME TO GIVE <br />AUTI�IUfiITY TO VIOLATE OR CANCEL THE PHOVISION OF ANV <br />O711EFi STA�E OR LOCAL LAW REGULATINO r,pNSTqUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br />OWNEFl OF TI115 PROPEFlTY TO PERFORM THE WORK FOR WHIGH <br />APPIICATION IS MADE AND I COMPIY WITH THE SiATE <br />CONTRACJII(iS LAW 1�27 RCNI!/FJ�96200 WAC. , / <br />MECIIANICAL <br />OF EOUIPMENT <br />A/C — MiNDLI <br />fUf10ED AIR S' <br />HEAT PUMP <br />UNIT HEA7ERS <br />CLOTIIES DRYI <br />WOOD ST(1VE <br />Mf_�AL FIR[PLACE <br />GAS RANGE <br />PI AN CI ICCk <br />�.`L <br />mmuu�c <br />� 111YpINO <br />MFI;:l�lllf.�l <br />AUU�IIONAI PI �N Cllf CM <br />Oi14f1 <br />fi1Mf IIIIIIb1116 SIIIIf11nIlOE <br />CITY OF EVERETT runnc wnnes <br />LOCALSALES — <br />TA% CODE IS J105 ioia� <br />SVB TOTAL f <br />PERMIT f <br />TOTALFEE f <br />fLf I �Ff.E1Pf NO <br />