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u <br />.�. -- <br />APPLICAT14�1 FQR CONSTRUC7 rON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />Cl DEM�LITION fl COMBINATION fl BUILDING I-1 MECHANICAL f 1 PLUMBING fl SIGN <br />PROJECT ADDRESS �. � ,� � , <br />OR DESIGNER <br />S� 3� c, <br />MAILAODRE55 <br />M�I� ADORE55 <br />3.s3-/3z � <br />cm <br />ui♦ nv PNONF. <br />d_•6,�, � �- 9!'z�a 3S3�as 3i <br />cirv zir riwNe sraieuceNse. <br />1J(SLt N' S rL `/ e%^^^�/ <br />MECHANICALCONTRACTOP MAILADDRESS CifY 2li` PIIONE STATEUCFNSE� <br />PWM9INGCONTR�CTOR MAILRDDRESS Cltt ZIP PHONE STATELICENSE� <br />OESCRIBE WORK �ND„OU�RI <br />�_01 J � <br />�� � ( <br />lVEI/J KOof <br />PROPOSED USE OF BUIl01Nd <br />tot <br />PLUMBINO <br />NO. TVPE OF FlXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK (SERVICE — BAq. El <br />FOpTAGEINVpLVEO <br />C <br />e�ocK _t� 0 D_ �r <br />IO�NLENOER.RDORE55. <br />FOR OFFICE USE ONLY: <br />fRONTSFTPRf.N � PEMSETBACK <br />❑SE20Nf�f IUT�PE� <br />�� <br />��r:im�r ur�rtnnoN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />� r+o or oweuinc <br />uNrtg ' <br />ES OGCUPRNiLOnD <br />RF�50�'� <br />nFncoH <br />1'I nNS MPnovFD ov <br />UAIE <br />HEATING ;;YSTEM: �I GAS I-1 ELECTRIC f-1 <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOR�TY TO VIOLATE OR CANCEL THE PROVISION OF NNY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED FV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />X L � N� /nC �� � ` �_ lD �' y� <br />SIGN 1T�RE DAIE <br />Cltt Bl1SINESSIIGENS[ N0. <br />TVPE OF EOUIPMENT FEE <br />A/C — A/HNDLG UNITS — H.P. <br />FORCED AIR SYSTEMS — B.T.U. M E.A. <br />HEAT PUMP <br />UNIT HEATERS — B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />1�IETAL FIREPLACE (WOOD BUFNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />EX:iAUSTFAN <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALGEE $ <br />S�OL SETBA � Pl AN G11FCK NUMAFR <br />_,.5� <br />VACRNI $IiF: FEES <br />IIYE+ �� pUILDMG � n <br />-, <br />sizE oF siocRi — <br />i0� $,F /ll'Onon/ riuuoir+r, <br />BASEMENi � MGQIANILAI <br />IIYE$ iyrNO <br />� W�I IONAL M AN CHECK <br />OiNER <br />sTni[ omioiuc suno�nnce <br />CITY OF EVERETT runuc wo��ks <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />ree _ ,, _ , .. 1 neccmt <br />� <br />