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APPLICATIO� FOR CONSTRUCT�N PERMIT� <br /> CITY OF EVERETT•BUiLDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201•257-8810 <br /> IId DEMOLITION ❑ COMBINATION ❑ BU�LDINfi p MECHAN�CAL ❑ PLUMBINO ❑ S16N <br /> PROJECTADDRESS <br /> �� �ui�om[ss arv zr qqr< <br /> '�' o+ E.vx1r 19.kJ W�frtae AJf �'nrfi a 9f�01 NlS-23J-8�/`! <br /> �E�"�* �•oacess cnr io pq�� <br /> /JICHILECTORLfSGNfR M�0.ADOPFSS CIiY S4 qq11E <br /> GENE11/.LCON}ql�CiOR LLUL�pCpE55 �irv SO qqHE g}�}E��(�� <br /> Aspfi Fi,✓;smwak/.`ro P•o, 8of3irl �k,�llm uN 9ra>,� yzS-.t/?�urYqpp.vf�sid,Db <br /> MECNANIC/iICCNiPK10N MAM1App1(55 CITY 1R Aq11E SL�IEIICEM$E• <br /> I'LUYOiNGCON�PI;iq1 MAII�CpRE55 LIiY Si ql�,Yl[ $IAiEIKEME• <br /> CONiMG!PpC!CF Kpil( <br /> � HEATIN6 SVSTEM: ❑�AS ❑ELECTRIC ❑_ <br /> OCSCf10E WOIIY.�Np Sq�ME(WIApE W V0.VED �pry},�f pER$OII IJq RIpE p <br /> / �n Uy <br /> 3(Z Z �1��e S 1 1 HEREBV CERTIFV THAT I MAVE READ AND E%AMINEO THIS <br /> c'roroseo usc a emiaxc NPPLICATON AND KNOW THE SA1AE TO BE TRUE AND CORRECL QL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLIEO WITH NRIETHER SPECIFIED MEREIN OR <br /> lEO�LOESCRPiqNpip{pp[p}y�5py��BFIOWORAiT�LNiWOLOP451 NOT. THE GRANTINa OF A PERMIT DOES NOT PRESUME TO ONE <br /> ior �p�y� a AUTNORITY TO VIOUTE OR CANCEL THE PPOVISION OF ANY <br /> OTHER STATE OF LOCAL UW EODU7INO CONSTRUCTON OR iHE <br /> PERFOPMANCE OF CONSTR ION.TH�T I AM AUTHORIZED BV THE <br /> OWNER Of THIS PROPER PERFORM TME WORK FOR WHICH <br /> APPLIC ION IS M�DE D I COMPLV WITH THE STATE <br /> riwcsuey iD ruu n CONTR TORS LAW 1B 7 W AND 298200 WAC. <br /> CWSiNULiqNlO/NlENOER.ApqIE55.iELERId1ENUMOEN % �`i[/� O �Z3'O/ <br /> S IURE �AfE <br /> CrtvBU5wES5LCEN5Elq. <br /> PLUMBINO M...HANIC�L <br /> �J. 7YPE OF Fl%TURE OP ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—MiNOLO UNITS i <br /> BA7HTUB ! FORCED�IFSYSTEMS ! <br /> UVATOflY(WASHBASIN) { HEATPUMP <br /> SHOWER UNIT HEATERS � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS <br /> DISMWASMER RANGE HOOD <br /> IAUN�RYTRAY � WATERMEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAI FIREPUCE(WOOD BURNING) <br /> ORINKING FOUNTAIN FIREPUCE INSERT(WOOD BURNI 6) i <br /> FLOOR URAIN GAS FIREPLACE <br /> BACKFLOW PREVENTERS GAS R�NGE <br /> SINK(SERVICE—BAR,ETC.) �AS PIPINO <br /> EXHAUSTFAN <br /> i <br /> i <br /> i i <br /> i �_ <br /> SUBTOTAL f SUBTOTAL S <br /> PERMIT S PERMIT S � <br /> TOTALFEE S TOTALFEE f <br /> FOR OFFICE USE ONLY: <br /> FRONTSEiO/LF RE�115Ei8�CK S�OESEIBKR %ANLMC�MI4BEP I � iEE NECEPitq. <br /> O��(J <br /> useza+e �orrnc� v�turtsirt FEES VALUIITION FEE <br /> OY[$ ❑MO BURfMq <br /> HEIGIIIlIMli�ilON IqOipKELLIN3 512ECiBlW�I1 <br /> Urvi15 RUMBM6 <br /> �p�NLY Iqtf5Ti1Mf5 OCCUPANiLp�O MSE4ENt ������,µ <br /> ❑�ES 01q <br /> in[SP11�imlERnE00 PF�SON ���4✓LMIM�WEGt <br /> O1NEP <br /> FRIC�lAR4RE0➢ q[ASOH <br /> STAiFlUlqtq SU11I?WqE <br /> rrreorcons.. w.us�ornovcoer CITVOFEVERETT axe�as <br /> LOCALSALES <br /> oeie TA%CODE IS 9105 TOTAL <br />