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APPLICATIOI�.FOR CONSTRUCTIOMI PERMIT � `` <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �s <br /> BUILDING DEPARTMENT HEATING SYSTEM: A f]ELECTRIC 0 <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION i I BUILDING CHANICAL ❑PLUMBING ❑ SIGN <br /> � AES GITv Zip VHpNE <br /> � �n �S C.��P�n � i��- J� 58'' bo <br /> TEN�NT �I� IMILADDRESS dTY ZiP PHONE <br /> MCX�CT�SIONER M��ppRE55 CITV zip p�pryE <br /> � I <br /> OENERALf�ITR�CTOR MA0.�DDRE55 CiT' ZIP PHpNE ST�TELICENSE� <br /> i` 1.� <br /> ��T�CNR MM�ADONESf GITv zip PHONE ST�TEUCENSE� <br /> • �x <br /> F1�1MlNGCCNTMCTOR WHlADD11E55 CITV ZiP PHONE S�ATELK.ENSEI <br /> �T I��`,5.�0 <br /> UESCRIBE WORK�NO SOWRE FOOI�pE�NVOlVEO CONT1Gi PERSON�ND PHONE t10 <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> rnoroseo oc euauMo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.Ai.L <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br /> lEML0E5CRIPTqNOFPRpVERTV�SIqWNBELOWORATTAGHTVOCOPIESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT eia� � NOT, THE GRANTING OF A PERMIT D�ES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUTING 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 /> PMCELT(OfIO.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296R00 WAC. <br /> OpqTRUCTONLWNLENDER.MDRE84.TELEPNONENUMBER Y •�� <br /> - E8� 1� 6aw I � � a*e <br /> � cmeusn[ssicewsc�o <br /> K�� MECfiANICAI <br /> N0. TYPE OP FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� NC—IUHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> IAVATORV(WASH BASIN) UNIT HEATERS—B T.U. M <br /> SHOWER CLOTNES DRVERS <br /> KRCHEN SINK 8 DISP VENT�LATION FAN ' <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAV WATER HEATER � <br /> � CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIFEPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING ' <br /> ROOF DRAINS--RAINLEADERS EXHAUST FAN � <br /> SIN!((SERVICE—BAR,ETCJ ; <br /> I <br /> � <br /> SUB TOTAL f ; SUB TOTAL S ' <br /> PERMIT f PERMIT f � <br /> TOTAL FEE t TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> Fqp1(f e(T�II�N REM SETB�CK SiDE$ETM[N PllUl�HECK NU4BEA FEE RECEIPT Iq <br /> uaEiorrt �or� vaclwrs�re FEES VALUATION fEE <br /> � VES - NO BUaDidG ; <br /> mtataat noassronrts ocaiw�c. wuo.tuncw�s � <br /> � PLUMBiNG <br /> � <br /> i <br /> BREOf/LDO fiRESVRNrtIERSPEtrO B45F4EHT MECMANICAL <br /> — VES - NO <br /> �W�MLYLWD FIAEFLARMRE00 ME�6NTlu/iT�Tpr� AODITION�LPUNCHECK <br /> OTHER • � <br /> 11FAlON ' <br /> STATE BUILOINp SURCHAR6E � <br /> WT/�KE�Y PUNSAPFROYEDlY CITY OF EVERETT PUBUC WOHKS ' <br /> LOCAL SALES <br /> o�re TAX CODE IS 3705 ror�� � <br />