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APPLICATIO ��.�%FOR CONSTRUCTI.sY�I PERMIT everett <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />Ihe Everyroen <br />CITV OF <br />everett HEATING SYSTEM: I] GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259•8810 <br />I I DEMOLITION I 1 COMBINATION i� BUILDING i' MECHANICAL I i pLUMBING I I SIGN <br />DyyTNEq MAILAODRF.S/S / r CIIV IZ�P PIIONE (�,,/ <br />TEIl�NT ��i� M�Il.pp��)— �LCiC9i�N J�v�GI1V ��`�� � PHONE J/ <br />ARCHRECTORDESIGNER M/ILADDPESS CIIY ZIP PIIONF. <br />QENER�LCONTRRC70R MAILAOORE55 CIIV ZIP PIIONE UCENSE� <br />CItrY ZIP <br />c�L1 <br />CIIY 21P <br />PI10NE . LICENSE • <br />I <br />SSOF WOfiK <br />NEW I I ADDITION i' AUERATION '! FlEPAIR �'�. UEMiOLI710N �� WOOUSIOVEiFRPL INSERT I i BUILDING RELOCATION <br />P�QO --- —'-" ---- I CONI�CI PEIISON�NUPIIONC 110 <br />� I <br />CONTPACT PRICE OF WORK /J ) �/ <br />DESCRIBE WORN AND SWARF. FOOIRG'c INVOLVED <br />�N��L� 4_I�1� <br />��oroseo use oF euao ac <br />LEML ESCRI f10NOFPIOPER7Y HOWNBEIOWOII <br />LOT BLOGN Of _, <br />PRQIECT ADDPESS <br />S4z5- Ao��w. <br />PLUMBINO <br />NO. TYPE OF FIXTURE OP ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY _ <br />CLOTHES WASHER <br />URINAL _ <br />DRINKING FOUNTAIN <br />FLOOR DHAIN <br />BACKFLOW PPEVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE--BAR, ETC.) <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />i roun cories� PROVISIONS OF LAWS AND ORDINANCES GOVEHNING THIS TYPE OF <br />WOFK WIIL 8E COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PfiOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br />SIGNATUAEOFCONifiPC10RORAU�HiIHIZEDAGENT � URTE <br />X �C <br />� <br />RPPL ANTSCITYBUSMES �ICENSENO.ANDPUSINESSNAME <br />NO. <br />SUB TOTAL $ <br />PERMIT $ <br />� FOR OFFICE USE ONLY: <br />� FPONiSElOACK IiF�O5E10ACK <br />I <br />usezor+e �ioinnen <br />iYVEOFCONiS.ALLOWABI[ IYPFOfLUNSCACIUAt <br />52E Of ALUC. --- _��_"NO OP S IOOIf:S ".. <br />LOr10 � PIliESPRNKLERS <br />�; INTANE BV <br />Wun <br />A/C—A/HNOLG UNITS- <br />FORCED AIR SYSTEM: <br />UNIT HEATERS—B.T.U. <br />CLOTHES ORYEfiS <br />VENTILATION FAN <br />RANGEli00D <br />WATER HEATER <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />8 CHIMNEY <br />ree <br />BUILDING <br />acururt. xnwnwnmmuxux — <br />cnnur PLUMBMC _ _ _ <br />nn5EnlENt--��-� --� MECHANICAL---� � — <br />NEIGIIILRAITA710N �DDITION�LPLANCHECK <br />oriien <br />STATE BUILDWG SURCHARGF. _ <br />CI1Y OF EYERETT PUPLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />� <br />� <br />� <br />