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APPLICAT'I�.N FOR CONSTRUC1.aN PEt�MIT/ <br />CITY OF EVERETT • BUILDING DIVISION yC� <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•887� � <br />❑ DEMOLfT10N ❑ CO►.S8INATION ❑ BUILDING O MECHANICAL j] pLU1A81NG C� SIGN <br />PROJECT ADDRESS: (Jn'� ,�/, '�j�n��v f ��;� /r-nF' 9 � <br />� - , r��-1 i �i iA . � <br />01�'NER MAll�0IX1E55 an nr� '�,,,,.�� <br />/. <br />MMl NY%1E55 <br />��� <br />Mu1 ADbnE55 <br />MMl �Wpf1E 5$ <br />� <br />Nu�eppnE55 <br />f.11Y <br />-:L I[x� <br />- - _2�u>I <br />71f' PHONE <br />III' --- p11UHG GI�1E IICENSE � <br />���01�1F ST�iE IICENSE � <br />MUEroMGCONIP11Gipi MM��ppf1E55 CIIY tln PIIONE STAfELIGENSE� <br />Mi m <br />tm <br />•NOSOU�REfOOIMtE <br />eioc� <br />� ��,��� - z-vii -aouco <br />CONSTRUGTION LON! lEN0ER.11Dd1E59. lEL[RqNE NWBEq <br />PLUMBINQ <br />NO. TVPE OF Fl!(TVRE OR ITEM <br />NUTER ClOSET (TOILET) <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />K�TCNEN SINI< 8 DISP <br />DISHWA3NER <br />LAUNORYtRAY <br />CLOTHES WASHEq <br />URINAL <br />DRINKINO FOUNTAIN <br />_� FLOOq DRAIN <br />BIICKROW PREVENTFRS <br />SINK fSERVICE — BAR FTc 1 <br />SUB fOTAL S <br />PERMIT f <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />IPONTSEiR�GK PE�RSfip��N <br />N�I N rl <br />USEId/E .� pE U � <br />0 <br />NEIONT UMI7�i1pN HO OF pW[�LtN6 <br />�.�,Il UNIIG �^ <br />�� ,.,r <br />OCCU'�NCY NO(If51MaE5 Of:CVP�NIl0�0 <br />F�RE <br />nF�S� <br />$IDE SFTBr�1c <br />.v <br />V�G�M Slf[ <br />❑�ES NO <br />S�2E OL BLUGRI <br />❑YES ❑ NO <br />IIEATING SYSTEM: rJ GAS ❑ ELECTRIC ❑ <br />cowur.r rmsor� um rvor� No <br />I HEREDY CERTIFY THAT I IiAVE READ AND F%AMINCO THIS <br />APPLICATION AND KNOW THE SAME 1'Q BE TRUE ANfI CORRECT ALL <br />PROVISIONS OF LAWS AND OR�INANCES GOVERNiM3 THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. T1{E ORANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTI�IORIiY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHCR �T".TE OR LOCAL LAW qEGUUTINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSYRUCTION. THAT I AM AUTHORIZEU HV THE <br />OW�JER OF THIS PROPERTY TO PERFORM THE WORK FOR 1A'IiICH <br />APPLICA710N IS MADE AND I COMPIY WITN THE S7ATE <br />CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br />x l �%/ � ilLCa�, <br />SIGN�jUjE O�IE <br />V( <br />CI7Y flU51NE55lX:ENSI NO <br />►IU• 7YPE OF EDUIPMENT FEE <br />A/C —M/NDLO UNITS <br />FORCED AIR SYSTEMS <br />HEA7 PUMP <br />UNIT IIEATE(iS <br />WOODSTOVE <br />METAL FIRBpLACE I <br />FIREPLACE INSERT <br />GAS PIPING —T— <br />EXHAUSTFAN � <br />�I�NCII[CN MIMpCII <br />StlLo � S <br />OUILUINC <br />riuumNn — <br />MFCi1nNICM <br />AUD�IIONeI PI�NCIIICIc <br />on¢n <br />z�nie nunonm sunnunac <br />CITY OF EVERETT rumir,vmnns <br />LOCALSAIES — <br />TAX CODE IS 3f05 ioTAl <br />SUBTOTAI S <br />PERMIT S <br />TOThLFEE S <br />fEFS� 3� ItFf.E1Pf NO <br />