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APPLICATIG.1 FOR CONSTRUCT..JN FERMIT <br />CITY OF EVERETT • BUILDI�iG DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-Q810 <br />❑ DEMOLITION 0�J f:OMB1NAT'tON ❑ BUILDiNG ❑ MECHANICAL fl PLUMBING I-1 SIGN <br />MELHl1NICALCIXJTRACTqP M�ULADURE55 Cltt ZIP GIIONE STATELICENSE� <br />PLUMBINGCONTRA�TOR MMLADDqE55 CIIV 11P PMONE ST�TELICENSE� <br />LONTRACT <br />UESCRIBE WORK AND <br />LOT � �p�K <br />cansrnucnorr <br />TEtEP110NE NlA1BEH <br />PLUMBIN6 <br />NO. TYPE OF fl%TURE <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KRCHEN SINK 3 DISP <br />� OISHWASHER <br />O DUNDRV TRAY <br />CLOTHES WASHER <br />_ URINAL <br />C7 DRINKING FOUNTAIN <br />� FLOOH DRAIN <br />BACKROW PREVENTERS <br />SINK (SERVICE — BAR. FTi <br />FOR OFFICE USE ONLY: <br />FqONT SETBACK pEM S <br />is �. % <br />I15E ION� � � <br />SUB TOTAL S <br />PERMIT S <br />TOTAL FEE E <br />IOTAR� <br />NO OF DWELtING <br />UNIfS <br />OLCUPANTl0�0 <br />RFASON <br />RE�S(Nl <br />� (r <br />VACANf SITE <br />❑YES ❑ NO <br />❑YES Q'Nn <br />HEATING SYSTEM: ❑ GAS J�9 ELECTRIC ❑ <br />LONTACT VERSONANO PNONE NO <br />I HEREBY CERTIFY THA7� ! HAVE READ qND EICAMINED 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 COMPIIED WITH WHETHER SPECIPIED HEREIN OR <br />NOT. THE ORANTING OF A PERMIT DpES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGUUTIN(i CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AIIhIOqIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANQ COMPLY WITH THE STATE <br />CONTRACT RS L 18 CW 2962001NAC. <br />x <br />SI NATURE DATE <br />CITY BUSINESS LICENS[ <br />NO. <br />PUN <br />� <br />NC—AMNDLG VNfTS <br />FORCED AIR SVSTEMS <br />v HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />MEfAL FIREPLACE (1N000 BURNING) <br />FIREPLACE INSERT (WOOD BURNING) <br />GAS FIREPLACE <br />D � RANGE <br />GAS PIPING <br />IXHAUST FAN <br />SUB TOTAL E <br />PERMIT S <br />TOTAL FEE S <br />BUIIDINf. <br />+ PlUM01NG <br />MEGNMlICAL <br />ADOIIION�L PLAN GRl.CK <br />0111EA <br />FEF I AEf.EIPi NO <br />STAIE BUIl01NG SIIfiL1UpGE — �� �� <br />CITY OF EYERETT ruxiir.wones 2 D� <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL —� i � i a <br />