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APPLICATIQ�'1 FOR CONSTRUCT.JN PERMIT <br />CITY OF EVERETT • BUILDING OIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOtJTION ❑ COMBINATION ❑ BUILDIING O MECMANICAL [� PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ,��, C11 � L.� ; r� I,� � n in rA d-.I v q Q�n I <br />01NIER MNI�DpRE55 CITY , IIP PIqNE <br />iE/MNi YNlA0q1E55 V GTY 71P PIqNE <br />MLMiCCTOROE5IGNER MIUlA00RE55 GITY 71f` PHONE <br />6ENEi1KGONTMGTOR MUL/�00RE55 �IIY IP P�IONE SGTEIICENSE� <br />oes ee waac �e o sou� <br />M10POSED USE OF MIpNU <br />�ak oEstnvnor� or rnov� <br />irn �aK <br />CORES) <br />CONSTPIICiqN lQW LENOER.11UOi1E55. 7ELEP110NE NIMlER <br />K�� <br />N0. TYPE OF FlXTURE OR ITEM FEE <br />WATER CLOSET (TOILE� <br />BATFITUB <br />UVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINIt 8 DISP <br />DISHWASHER <br />IAUNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DqINKIN6 FOUNTAIN <br />ROOR DRAIN <br />BACKFLOW PREVENTERS <br />SUB TOTAL <br />Fi <br />TOTAL <br />FOR OFFICE USE ONLY: <br />F110NT SEis�pf pEM SET&1CK 51DE SETBnCK <br />USE iONE <br />IIEI6HT LM1IT�TION <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC p <br />LONT�CT VEFSON I1N0 PIIONE lq <br />1 HEREBY CERTIFV TMAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE THUE AND OORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILI BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITV TO VIOUTE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW RE6ULATIN4 CONSTRUCTION OR ?HE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CO CT RS W 1827 RCW AND 296200 WAC. <br />x_I��e.� �f-a�-9� <br />SIGN� URE D�7E <br />pTY BUSNESS LICENSE NO <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVERS <br />HANGEHOOD <br />WATER HFATER <br />WOODSTOVE <br />METAL FIREPUCE (WOOD BURNING) <br />FIREPIACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />IXHAUST FAN <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE S <br />PlANC11ECKNUTABER fEF RFCEWINp <br />loi �RE� VAGINT S�TE FEES <br />OYES ❑ � Bltll0lNf. <br />HOOFCMELUNG 512EOFllpC/fl <br />UNITS �I IIMOING <br />OLClM�N710�0 BASEIAENI MECII�NICAI <br />❑vE5 ❑ NO <br />REI150N �DD��ION�L Pt AN C��f.LN <br />011�En <br />RE�CON <br />STATE BURUIN6 51111CNAfqE <br />PLANSAPPPOVEDBY CITY OF EVERE7T �IIpIIf, WO11RS <br />LOCALSALES <br />m�c TAX CODE IS 9105 TOTAL <br />