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APPLICATIO� FOR CONSTRUC�N PERMIT <br /> CITY OF E\�ERETT•BUILDING DIVISION �� <br /> 3200 rEDAR STREET• EVERETT, WA 98201 • 259-8810 <br /> I 1 DEMOLITION f I COMBINATION i ! gUILDING I I MECHANICAI � 1 p�UMBING I 1 StGN � <br /> PROJECT ADDRESS �! �/ <br /> ���(�� �� l (�='/RJ �%r�/���� � ,:i .� � //.-• /��' �r':�� <br /> ovrt�[rt� _ nn eoonc5s cin zm r��or+E <br /> �J OP i it.t' -�)/�)/�a it�t <br /> iENRNT MRII.^ O�F55 � GtV IIP p110NE <br /> � <br /> MCNIiF.CTOpOF51GNFP M�II�D[JRE55 CIiV )IP PNONE <br /> GENER Nt CI(M M�qAD�p[55 f�.nv )iP P11t',Nf S1�TELICGNSE� <br /> -�r ��, , , o � .. , a �. <br /> MELMIINICRLCON7R�dOf1 MnILAppqF55 CIiV ]IP PIIONF. Si�TELICENSE• <br /> 1`LUMCINGCONiq�CTIXI Mnll�fl0qE55 Clfv )IP PHONE STQEUCENSE� <br /> CONTq�CT PRICE OF WORN <br /> HEATING SYSTE.M: ( I GAS f 1 ELECTRIC f� <br /> OESCRIBE WORN�NO SdURF FOOT�GF INVOIVEO CONT�LI PFRSON�ND�IIONE NO <br /> I HEREBY CEiiiIFV THAT I HAVE READ AND E%AMINED THIS <br /> PNOPOSE�USE OF AUILDINQ APPUCATION AND KNOW THE SAME TO BE TFUE AND COPRECT ALL <br /> PROVISIONS OF LAWS AND ORDINANCES dOVERNIN6 THIS TYPE OF <br /> WORK WILI F�E COMPL'ED WITH WHETHER SPECIFIED HEREI�' OR <br /> LEOALOESCNIPTIONOFPqOPERLY�SMOYMBELOWIXI�TT�CHTWOCOPIES� NOT. THE OPANTIN3 OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ior e�ocK or AUTHORITV 70 VIOLATE OR CANCEL THE PROVISION OF ANV <br /> OTHER STATI.OR LOCAI LAW REOULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM A�THORIZED BV THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPUCATION IS MADE AND I COMPLY WITH THE STATE � <br /> P�fICELT�%10.NUMBER CONTRACTURS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LO�N lEN0Ef1.��DtlESS.iELEPMONE NUMpER x—_ . � •��-L��J�� <br /> 7 <br /> �'ONRLI111E U�iF. <br /> CITY OOSMESi IICENSF NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF fl%TURE OR ITEM FEE . NO. TVPE OF FU(TURE OR ITEM FEE <br /> r; WATER CLOSET(TOILET) i A/C—AMNDLG UNITS�—H.F. �— <br /> � BATHTUB ; FORCED AIR SVSTEMS--B.T.U. M E.A. ' <br /> � <br /> � LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER � UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK d DISP i CLOTHES DRVERS � <br /> DISHWASHER � VENTILATION FAN i <br /> LAUNDRVTRAV � RANGEHOOD � <br /> CIOTHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE � � <br /> DRINKINO FOUNTAIN i METAL FIfiEPLACE(WOOD BUPNING) ; <br /> FlOOR DRAIN � FIREPLACE INSERT(WOOD BURNING) i <br /> BACKFLOW PREVENTEPS ; GAS FIREPLACE ' <br /> SINK(SERVICE—6AR.ETC.) 6AS RANQE � <br /> ' GAS PIPINO <br /> — � <�— - i EXHAUST FAN � <br /> � � <br /> _ SUB TOTAL 3 ' SUB TOTAL S ! <br /> PERMIT S � PERMIT § � <br /> TOTAL FEE 5 / � TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> fllONi SF�p�CN PGM SETpAfN SIDE SFTB�CN PL�N CIIECN NUyQFR FFE RFCEIPT NO <br /> / l�-1 <br /> �' <br /> USE20NE ioiene� vnceNrsrtF FEES VALUATION FEE <br /> I1YF5 I1 NO <br /> lIUII�iNA <br /> HEI4NT LIMIUTION NO 0�UWCLLINO SIIE Of NlIXt41 <br /> UNpS <br /> PLUGHINO // ��(J I <br /> OCCUPANCV NO O�Si0RiE5 OCCUP�NtLOAp B�SEMENT � (r <br /> OIiOUP MECN�NIC�I <br /> I7YE5 Il NO <br /> FlPEAL�RMPEOD qF�50N ADOItION�LPL�NCNECK � <br /> � <br /> Ot11ER i <br /> FIRESPRINIRERPE00 FF�SON <br /> � <br /> S1�1E BUIl�INO SUPCN�OOE � <br /> 1 <br /> rmE ov cor+st r�.eNs�rrnoveo nr CITY OF EVERETT ruxnr,wora5 I <br /> LOCALSALES ' <br /> oe�e TAX CODE IS 3105 TOTAL <br />