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APPLICATII.N FOR CONSTRUCI.ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259•8810 <br />�l DEMOLITION i l COMBINATION � BUILDING I MECHANICAL f 1 PLUMBING SIGN <br />PROJECTAODRESS n��2 „�,`��� <br />�- uur�r <br />cirv <br />Tlr <br />1i� PHONE <br />MECHnNIC�L CONTqn�IDR MAIL ADDRE55 Cltt lIP PIIONE STATE LICENSE � <br />PLUMB/IN�GCONTR4CTOR MAIL�ODPE55 CITV <�P PIIONE STAiELICENSE� <br />(. %Q� <br />CON �CT PNICE OF WORN <br />�or <br />cnace� uz i.o. <br />oc emiomc <br />PRO7EPTV (SHOWN BElO' <br />BLOCN OF <br />CONSTPUCPONLO�NLENOER,pUDPE55,TElEPNONE NIIMBER <br />NO. � TVPE OF FIXTURE OR <br />WATER CLOSET (TOILETI <br />SHOWER <br />KITCHEN <br />LAUNDRY <br />CLOTHCS <br />SUB TOTAL <br />HEATING SYSTEM: f 1 GAS f-7 ELECTRIC (l <br />CONTACiPFR50N�ND_f'110NEN0 _ . <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINEO 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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />coriEsi NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br />PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEfi OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT ACTORS LAW 1827 RCW AND 296200 WAC. <br />X�i�� 5 rB -9S <br />SIONFTURE D�TE <br />FOR OFFICE USE ONLY: <br />FRONTSE7B4CK qEAR SFT�nCK SI�ESETBACR <br />USE ZONE <br />HEIGMT LIMITRiION <br />CONST <br />lOi ARErI <br />NO OF DWELUNG <br />UNITS <br />OCCUPANTIOAp <br />RENSON <br />pTV BUSMESS IICENSF N0. <br />FEE NO. TYPE OF FIX7URE OR <br />T A/C—AMNDLGUNITS—H.P. <br />� FORCED AIR SVSTEMS — B.T. <br />—? HEAT PUMP <br />—•- <br />UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />� VE�TILATION FAN <br />� RANGEHOOD <br />� WATER HEATER <br />' WOODSTOVE <br />i METAL FIREPLACE (WOOD BU <br />� FlFEPLACE INSER7 (WOOD BI <br />i GAS FIREPLACE <br />� GAS RANGE <br />GAS PIPING <br />i E%HAUSTFAN <br />VAGANT SIiE <br />flYkS fl NO <br />DIIILOING <br />SIZE 06 BLDG/f I <br />�J� <br />oa,E - � � <br />fEE <br />M E.A. <br />SUBTOTAL $ � <br />PERMIT $ <br />TOTALFEE $�—� <br />AFIE� F[E PFCEIPT NO. <br />��_l � <br />=EES VALUATION FEE <br />/' ��i � <br />PIUMPING <br />p$EMENT MECHGNICRL <br />flYES f71J0 <br />AOOIIIONaL PLAN CH[CK <br />OtHER <br />STATE 9UIL�ING SURCHPRGE <br />CITY OF EVERETT rut+��c wonKs <br />LOCA� SALES <br />TAX CODE IS 3105 7o7AL <br />