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APPLICATIG�! FOR CONSTRlIC7 .ON IPERGIAIT <br /> CITY OF EVEFETT• BUILDIf�G GIVISION � <br /> 3200 CEDAR STAEET• EVERETT, WA 98201 • 259-8810 <br /> �� OEMC�LITION i COMBINATION i-I gUILDR�G f 1 MECHANICAL i� p�UM81NG ( 1 SIGN <br /> PHOJECT A DRESS ��� <br /> �E� NAiLADDPE S CITr IIP ^ ��.yE <br /> ` �� � 7 L1✓ <br /> TE ANT MnILAWRE55 � �ITY � 21p ( FIIONE <br /> a �i�l,VC't r I <br /> AAp�RECTOR�E5IGNEP MAILNDORE55 QTV Ftp pq�E <br /> CaENEFALCpN7q�CTIX7 MRILROORE55 Clry 21P PHONE STAiEUCENSEt <br /> ME]CHaNICALCONTAACTOR MAILA�pRE55 qTy 21P PIIONE STAIELICENSE/ <br /> _ T7'Y�CSN� <br /> PLUMBINaCON1AACTOR MAILADDRE55 piV ZIP PHONE <br /> STqT[LICENSE 1 <br /> ONTqqpTPRICEOF K � 0� <br /> HEATING SYSTEM: ❑GAS fl EIECTRIC f-1 <br /> DESCRIB[V1OPK ANp SOUARE FOpi�GE INVOLVEO� : 1A�T PEPSON ANO PHONE NO <br /> / K $ - �( l`7 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> na voseo vse or eonowo APPLICATION AND KNOW THE SAAAE t0�E TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND ORDIIJANCES GOVERNING THIS TYPE OF <br /> ������ � WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEWLDESGRIPTIONOFPROPEFTY(SHOWNBELOWORATTACHTWpCOPIE51 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> ��t e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW FiEGULATING CONSiRUCTION OR THE <br /> PEHFORMANCE OP CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PE�iFORM THE WORK FOR WNICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> anace�rnx i.o.Nurneeq CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LORN LENDER.ADOHE55.TELEPNONE NUMBER r')r( O ' `�— <br /> IGNAIUR DATE <br /> CITY BUSiNECS IIGENSE N0. <br /> PLUMBIN6 MECHANICAL - <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF FI%TURE Oq ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. , <br /> BATHTUB ; FORCEOAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � HEAT PUMP <br /> SHOWER � UIJIT HEATERS—B.T,U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> LAUNDRY TRAY � RANGE HOOD � <br /> CLATHES WASHER � WATER HEATER , <br /> URINAL � WOOD STOVE <br /> DRINKING FOUNTAIN i METAI FIREPLACE(WOOD BURNING) ' <br /> i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD DURNING) � <br /> �ACKFLOW PREVENTERS � �AS FIREPLACE � <br /> � <br /> SINK(SERVICE—BAR, ETC.) � GAS fiANGE � <br /> ' GAS PIPING � <br /> � EXl1AU5T FAN � <br /> i � <br /> i <br /> i ' � � <br /> i <br /> i <br /> SUB TOTAL $ �l SUB TOTAL $ �"f � <br /> � <br /> PERMIT S i � PERMIT $ � <br /> TOTAL FEE $ � � TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> fPO4T5ETBACN REAPSF.T[1ACK SIDESEiBACK P�AN�HEC NUM�ER P[E FECEIPTNO. <br /> / �(G%�.� <br /> usezoNe io�r,vEn vneaNrsire FEES VALUATION FEE <br /> nres n r+o ew�oieo � <br /> NEIGHTLIMITAi�pN NOOP:1WELlINQ SIZEOiBIDGrtI. <br /> l/N1T5 <br /> PIUMBING . � j�� <br /> DCQ/PANC1 NO OF SiURIES OGCUPANT LOAD gASEMENT M[CHANICAL <br /> GROUP �J� )C� <br /> I]VES fl IJO <br /> FlREALARMRE00 R[ASON AUDITIONALPLRNCNECK � <br /> i <br /> i <br /> OTHER � <br /> � <br /> FIRESPPINNLERREO'0 RF.ASON <br /> STA1[BUIL�INO SURCH�ROE i <br /> TYPEOFCONST PIANSRPP ONEOBV CITYOPEVERETT PUALICWORKS � <br /> ��`i LOCAL SALES ' <br /> oniE j TAX CODE IS 3705 7oiAL � I -- <br />