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APPLICATIO� FOR CONSTRUCTION P�:RMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 96201 • 259-8810 <br />❑ DEAAOLJTION p COMBINATION ❑ BUILDING ❑ MECHANICAL � PLUMBING ❑ SIGN <br />PROJECT ADDRESS: ���J <br />�i <br />; ��330 � dP u� <br />cm ziv vHp,E <br />r�a3 �,n�ti �f �o� <br />� � L�TY ZIP PIIONE <br />ARLMTCCT OR DESiGNER M�II hDDRE55 GTY IiP PNONE <br />as a -���� <br />GEHERI�ICONiR�CTOR MIUL/�0(MESS CIfY Im PNONE SGl[IICENSE� <br />MECN/J11C�LCONTRICTOR MMLADDRE55 fAIY Z�P PIIONF 51�TELICENSE� <br />� PIUMBMG <br />Y <br />oescroee woro� �r+o sou•ne rooT�ee x�vaveo <br />LOT �p�l( <br />CONSTRULTION LOM! lENOER. �DqiE55. TELEPNONE M14BER <br />PLIIMBRI(S <br />NO. TYPE OF FlXTURE OR ITEM <br />WATEF CLOSET (TOILEn <br />BATHTUB <br />� UVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />L! FLOOR DRAIN <br />SUB TOTAL S <br />PERMIT f <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />iRdITSETflGLN RE�RSFTBALK <br />USEIONE IOTeREA <br />HFIGNT L�MIT11i101: Iq OF DWEIIING <br />UNIfS <br />occuvnr�cr I �a a <br />GROUP <br />O�TE <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />CONT�CT VERSON AND PIqHE NO <br />I HEREBY CERTIFY THAT i HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROV�SIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLIED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE ON CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL lAW REGULATINQ CONSTqUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH TNE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />CITY 9U$INE55liCENS[ NO <br />MECHANICaL <br />FEE NO. TYPE OF EOUIPMENT <br />' A/C—AMNDL6UNfTS <br />; FORCE� AIR SYSTEMS <br />—T HEAT PUMP <br />' UNIT HEATERS <br />� CLOTHES DRYERS <br />� RANGEHOOD <br />; WATEfl HEATER <br />SIOE SEiB�CN <br />VACANT SIIE <br />❑VES ❑ NO <br />512E OP BIOGRI <br />B�SEMENI <br />❑vE5 ❑ NO <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PIPING <br />�UST FAN <br />PUN CIIECN NUA10[R <br />BWI�INf, <br />P111M01NG <br />MECH�NICQ <br />•�DIIIONeL Pl �N CIICGN <br />on�en <br />sreiE owtoiac suncN.nce <br />nuoi �r, wonKs <br />TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />�Ef I REf.EIPI NO <br />