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APPLICATIQ" 1 FOR CONSTRUCT'''1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I <br />�i9-8810 <br />f I DEMOUTION I I COMBINATION <br />n�na noenrss <br />HEATING SYSTEM: �GAS U ELECTRIC ❑ <br />U BUILDI'NG <br />�r <br />i F�1�N7 IANL ApORF S$ CII V <br />MCNIIECTO�OESIONE� AINLAD0f1C55 f,l1Y <br />Zm <br />!� <br />Dr <br />PIIONF <br />I 1 PLUMBING LJ SIGN <br />CENEfi�LCONIP�C10� IdMLAUf1PF5: <br />CIIY 7.IP PIIOIlE StnrEUClt�SE/ <br />--- CIIY IIP PIIOtlE SINEUCENSE• <br />MEG114NICALWtllfipClOfi MNL�DI1tiF5S _ _ <br />CONifiACT PRICE Of WORK <br />oS-43 O.00 <br />OESCfiIpE WOfiK ANO SOUME �(%�InCE INVOI Vf❑ <br />t R'�FOSEO USE OF BUILOING <br />�[G�L UESCP�P� �ON O� ��OPEt1iY �$I IOWN 0[LO'N Ofl Al14Cl I iW0 COt'IES) <br />lot o1.ocK or — <br />SI�iF. LICENSE � <br />Cornncr renso�riy�p rno�+e� u�o ^/' �. � <br />_-_ —!_ !-oS��K-/-Y�-� <br />------27�=�3/�- <br />t HEREBY CERTIFV THAT I HAVE READ AND EXAMINED 1HIS <br />APPUCATION P.ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />Pl70VISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILI BE COMPLETED WITH WHETIIER SPECIFIED HEREIN OR <br />NOT. THE GR�NTWG OF A PERMIT DOES NOT PRESUME TO GI\'E <br />AUTVIORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTRER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEF1fORMANCE Of CONSTRUCT!ON. THAT I AM AUTHORIZE� BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH�CH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />rnncEl �nx i o Nuem[n CONTf1ACTORS LAW 1827 RCW �ND 296.200 WAC. <br />�9�3–OOo–OQ71–DOo� � / <br />r,onsinucna+ionr+ieNoen.no^ness.ineruor+r:uunit�rn //y CL�� -v1��� <br />_-'__-'_-_ Y / /1 __�! — nnrt <br />PRUJECT ADDRESS � ��_"�S�_ . _QQT %LS-1 - <br />WATER CLOSET (IOILF I � __� <br />BATHTUG <br />LAVATORY (WASH BASIN) <br />SHOWER _. <br />KITCHEN SINK 8 DISP . <br />DISHWASIiER <br />LAUNDRYTRAY <br />CLOTIIES WASH�R <br />URINAL _ <br />DRINKING FOUNIAIN _ <br />f-LOOR DRAIN _ <br />BACKFLOW PREVEN7ER5 <br />ROOF URAINS-RAINLEADEFiS <br />SINK (SERVICE-BAR, ETC_) <br />SUBTOT�AL $ <br />PERMIT 5 <br />IOIALFEE $ <br />FOR OFFICE USE ONLY: _ <br />fRONf5E1BACN OFMSF104CK <br />usczoNe �oinnen <br />I <br />I -- <br />rvreovcoi+si. r+oorsronirs <br />52EOfOLOG. flfifSPNNH![I15fi[O'D <br />i <br />. (N:CUPANf,V LJAO Flf1E �LA11A1 f1G0 P <br />INIAKE BY <br />vinr�s nrrnoveo <br />nni� <br />FEE NO. TYPE OF E�UIPM <br />� A!C-AIIINDLG UNITS-H.P. <br />� / FORCED AIR SYSTEMS-B. <br />� <br />, UNIT HEATERS-B.T.U. M <br />� CLOTHES DRYEFlS <br />; VEN'IL�TIONFAN <br />--�-- RANGE HOOD <br />� / WATER HEATER <br />-r � WOOD STOVE <br />� � METALFIREPLACL(WOOD <br />---{-- -- -- <br />� FIREPLACE INSEFlT <br />---�—� --- I�IEAT PUMP <br />—'---- <br />; � GAS P�PING <br />--i— � EXFIAUST FAN _ <br />--'-- -- --- <br />� <br />--'r-- --" — <br />_a_ __ _ - _ _.-__ __ <br />i <br />___ <br />—i —_ _' <br />� <br />---r--- - - - ---- <br />� <br />SIDES[lOACK 1'I.A��CHF.CKIIIII. ER � FE[ <br />vncnursnr FEES <br />f I VES f � NO p��ll �ING <br />rcarnn•,. im m �+cmnv,inins -- __.- ____.-_---- <br />r.nm�r - - - - pLU1dBI1JG <br />Bns[nRwr MECII�IJICAL <br />I I YES I I NO ------ <br />IIfIG11t111A17AT101! ADDIfIONALPL�NCIIECK <br />onir-� <br />S1NE 4�UILUING SURCIIARGE <br />CITY OF EVERETT rum-icwo�Ks <br />LOCAL SALES <br />TAX CODE IS 3105 �orn� <br />M E.A. <br />SUB IOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />