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APPLICATI010FOR CONSTRUCTIf1 PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br />259-8810 /' �rinOcr <br />I. I DEMOLITION 1.1 COMBINATION I I BUILDING III MECHANICAL I:) PLUMBING ❑ SIGN <br />('ommuni �yTansil <br />7000 Hz1rd,-soo KJ. Evcr <br />-y <br />98,703 <br />A CNRECi ORD[SIGNF <br />mdl4nsf-j <br />MAL ADpnL55 CITY <br />see 4aelow <br />TIP <br />PNONE <br />GENERAL cEPInAClOn MAI- ADDNLSS ]� Cli <br />a d oun� �o•13�x(o� Q �el�pv�n <br />ZIP <br />9f3oyR <br />PIgN[ STATE LEENSE0 <br />H51 88�3 <br />MEbMNCALCONTRACIM <br />M�-V-inaPo•13o�a�5(Q� <br />M AIXID[55 CITY <br />TIP <br />MgNC SIAIE LICENSE• <br />PLuVrPtGcENTIIArlO,f <br />MAE ADDNLSS CRY <br />ZIP <br />PHONE STATE LCENSE1 <br />t UIInACI IY1FL lX YICIM <br />GvcreGl uT on ITaI subrnl aI <br />low-9L. <br />DI SCHME WOnx AND SQUARE rOOTAGF INVOLVED :rllfall -fire, <br />_ <br />CONTACT PRISON AND PHONE W na e of Z <br />rinKlfrg`ln palRi 5 ra o <br />��ppily <br />- 6 4- <br />ONO�1D- j(o9 <br />1 HEREBY CERTIFY THAT I 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 COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 29G.20G WAG. <br />pY <br />/y/�LTKp--! T <br />�,H+� &(CAI L� 1T <br />Ir14nMI SSIGxv MI �� <br />7x n2 <br />}I <br />PIKKnsEo usE aeunDlNG rii11 I' 1YacI �p0' • - <br />r <br />LEGALMWIlIPTKxla PnOERWISHOWNRELMOIATTACH WACOPKSI <br />LOT— REM.oc <br />PARCEL ux to rvuMREn <br />-0000 <br />CONSTRUCT ON LOAN LENDER ARDREss.1nIX1 ERIE NUMBER <br />PROJECTADORE P R C�. G Ye1�fl /C��O <br />V <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILETI <br />A'C-A HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />I <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />_' <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I <br />EXHAUSTFAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL E <br />SUBTOTAL E <br />PERMIT S <br />1 <br />PERMIT E <br />TOTAL FEE S <br />TOTAL FEE E <br />I FOR OFFICE USE ONLY: <br />SPRLVKLEnSREOD <br />Tt —AA MRE➢D <br />MASON <br />WAKE RY <br />❑ YES ❑ NO <br />BUILDING <br />141KY <br />NIOP <br />IMoonu4LMu <br />PLUMBING <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PUN CHECK <br />NEGM WRAIXJN <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />.�O <br />