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� Y <br />APPLICATIC^l FOR CONSTR!lCT�1N PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA �J8201 • 259-8810 <br />MECHANICQCONTRACTOR MAIL�DDHE55 CITY 21P PMONE STATELICENSE� <br />PLUMBING CONTR�CTOR M�ILAODRE55 Cltt ZIP PNONE STAiE LICENSE • <br />L[CML OESGfUPTION OF PpOP� <br />LOT g�p�K <br />�'Q��� " � " C-�_'l_�i <br />NISTRUCi�ON LONI LENDER, ADD{1E55. TELEPHONE NUMBER <br />.UMBING <br />NO. TYPE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SUB TOTAL E <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK qEARSETBACN <br />USE20NE tOt�REA <br />HEIGMT UMITATION NO. OF DWELLING <br />UNIfS <br />AiD <br />R•EM�'[ <br />ryY <br />SIDE SETB�CN <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />I HEREBY CERTIPV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION aND KNOW THE SAME TO BE TRUE AND CORRECT qLL <br />PROVISIONS OF LAWS AND ORDINANCES CaOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHcTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS ADE AND I COMPLY WITH THE STATE <br />CON T q W 1B. . C1b AND 296200 WAC. <br />x '� �3 9 . <br />SIG �TURE ATE <br />(�Gu Y 9USINE55 UCENSE NO. <br />MECHANICAL <br />NO. TYPE OF EpU1PMENT <br />A/C—AMNDLG UNO"S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />MEfAL FIREPLACE (NJOOD BURN <br />FIREPLACE INSERT (WOOD BURP <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />IXHAUST FAN <br />' SUB TOTAL E <br />PERMIT E <br />TOTAL FEE E <br />PUNCIIEGNNUMAER If[F � ��� IRECEICTNO <br />ACANT SIiE FEES <br />❑YES ❑ NO pU1101N6 <br />' e�ocrr i <br />� � �� PLIIMDING - <br />ASEMENT MECHANICAL <br />❑YES �(NO <br />ADDIfIONRL PUN CMECN <br />orHen <br />ISTATE BWl01NG SIIRCHAqGE <br />CITY OF EVERETT ruour, wonres <br />LOCAL SALES <br />TAX CODE IS 3105 7O7AL <br />FEE <br />r <br />