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APPLICATI�.N FOR CONS'rRUC1.ON PERMIT <br />CITY OF EVERETT • �UILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I I DEMOLITION � I COMBINATION �'� BUILDING I I MECHANICAL � PLUMBING �! SIGN <br />PROJECT ADDRESS ��� � <br />orrrtn `J� uanaoonrss /�/ <br />" •--e-�,�.Z�l �%)..���C.C/l'v <br />IENRNI M�II ADDiiF55 <br />U✓� <br />GIiNE{ULCDiliR�CIOR 6�qp.FpDf1G55 CfIY ]IP P1104f $lAT[IIC[NSF.� <br />MELH�NICFLCONiReC10f1 A�AILnUDRF55 CITY :iP PIION[ STnTFLICENSE� <br />MNL A[)OFESS <br />CONIR6Ci <br />DFSCRIOE WOPK ANO SOIIAPF FOOTAGE INVOLVED <br />/)ii.. �_ / � n _ <br />LEW l OESGRIPTION OF PRJPEPTV �SHOWN tlELOW OR ATiPCM i W0 CO�IF.S� <br />ior __c�__ e�ocK or��cU1ZS <br />L�i4.CF �PE la.f,�I�N �it/k�t.S C'o.QDi <br />��rT�Eoii�a�% ., '� �y/,.F. <br />PAPCEL TRC I 0. NUMfiER <br />CONS1qUCTION �O�N IENUER. AD�RE55. TElEP1lONF NUMP.ER <br />� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV (WASN BASIN) <br />SHOWEH <br />KITGHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHEP <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAR, ETC. <br />PERMIT S <br />TOTAL FEE 5 <br />fi1V <br />0 <br />STAiE LILENSF. � <br />HEATING SYSTEM: f 1 GAS f 1 ELECTRIC f� <br />f O4TA(:L Vk PSON ANp PIIONE NO <br />I HEREBV CERTIFV ?HAT I HAVE READ AND EXAMINEC THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVEFNING THIS TYPE OF <br />WORK WILL AE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVr <br />AUTHORITV 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 BV ThIE <br />OWNER OF THIS PROPERTV TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 1 7 R 6. 0 WAC. <br />X J <br />SIGf E pAi <br />C�tY PUSMF.S� I IC[NS[ NO <br />N0. TYPE OF FI%TURE OR ITEM FEE <br />A/C —A/HNDLG UNITS — H.P. i <br />FORCED AIR SYSTEMS -- �.T.U. M E.A. � <br />HEAT PUMP —� <br />UNIT HEATERS — B T.U. M � <br />CLOTHES DRYERS i <br />— �— <br />VENTILATION FAN <br />RANGEHOOD <br />WATFR HEATER � <br />WOOD STOVE <br />METAL FIREPLACE (WOOD DURNING) i <br />FIREPLACE INSERT (�VOOD BURNING) � <br />GAS FIREPLACE ; <br />GAS RANGE � <br />GAS PIPING � <br />ExHAUSTFAN i <br />FOR OFFICE USE ONLY: <br />F110NTSCTOACN � REMSEi[1ACN SIpESFip4CK PIANCIICCN <br />zE� S� 5 a zG E,tSaW � <br />U�E IONE� 1 <br />MEIGIITtIMITRiION � <br />OCGUPANCV 0 0 Sii <br />�����,_ <br />PI iE PLMM REO � <br />FIRE E '1 IN�R f1E0'D <br />IU V <br />i or nn�n vncnm sire FEES <br />�r � �i ��a nres � r�o nuuo��ae <br />�P <br />NOOfOWCILING SiZFOfOIOGTI — <br />UNI�S � PWA10'.NO — <br />� �7 � Sf G.aa <br />OCCl1PANilOAD PRSFMGNI E�ECH�NICAL <br />IlYlti u0 - <br />f1f.A;01 ADDIIIOM1AL PUN GHCfK <br />OiM[R <br />RFASON --- — <br />S7AiE OUIIDING SIIRf,lU11G[ <br />r�nNsnrrrov,fnnv CITYOFEVERETT r��mur,worh�s <br />}'� LOCALSALES <br />�,,.� �/,� /AQ TAX CODE IS 3105 TOTAL <br />SUBTOTAL S ; <br />PERMIT S i <br />TOTAL FEE 5 ' <br />6F.F�RfCPIPTNO ' <br />� ,o / /.� � ,- — <br />� <br />�VALUATION FEE <br />I Z '-�S�o /�/�/ i n, � <br />��. <br />