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APPLICATION FOR CONSTRUCTAN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • E'JERETT, WA 98201 • (425) 287-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />0 <br />MFCNANICAI CONTRACTOR MAI_ADDRESS CFO bP NACRE SIAIF LICENSE• <br />PI RMBING CONE FACTOR MAIL ACCRFSS CITr PP P110YF STAFF MENSFI <br />CONT 1 PREgf.N'p1yA"J <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC Cl <br />DNVIII ICO11lNE F EAc ( fq <br />3 Jt t <br />cONucr PrnsoN AND PRONE ND <br />[e[Q� <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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 I COMPLY WITH THE STATE <br />CONTR TORS LAW IB 27 RC# AND 296.200 WAG, <br />X MF � lelzl <br />FREI USE OF BUILDING <br />EFOAL D[SCRIrnpl or PROPERTY ISNOxTFenowan AnACN Iwo COPIES) <br />EOI BLOCK or <br />PARCEL m to MENDER <br />CONSTRUCTION LOAN UNDER. ADDRESS. MIEPRONE NUMPER <br />SIGDAM <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C—AAINDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCH'_'N SINK A DISP <br />CLOTHES DRYERS <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />_ <br />DRINKING FOUNTAIN <br />PREPLACE INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />SINK (SERVICE —BAR. ETC.) <br />GAS PIPING <br />EXHAUSTFAN <br />_ <br />SUBTOTAL $ <br />SUB TOTAL S <br />_ <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />r PON15r1PAIX <br />RFAn Sf IBACN <br />510E SETBACK <br />PLAN CII[CK NOµIfR <br />S(/r/_oFFEEEESS <br />r( <br />A,rr"INO <br />1l1ZONE <br />Im AREA <br />vACAII <br />❑rC5 D NO <br />VAL ATION <br />FEE <br />--FEE <br />ioc7ioc� <br />Nf I.'AR I14IIAN04 <br />—I. <br />NO pUWfIIINO <br />511E Of BIIXYII <br />M1 114NINn <br />117 lil`A `.I:Y <br />Y� Ill„ <br />N"'I <br />V('flll`ANI LOAD <br />BASFMCAR <br />Drf$ ❑ Na <br />4(I:NANI('.AI <br />—;— <br />ADp110NA1%AN CNFCM <br />FINE JVHryMEP RED 0 <br />RINION <br />GRlrn <br />---i <br />IRE AuurAum'o <br />nF AERv <br />BWE nUM1OWO 511PC11A0GE <br />,�J-� <br />IrrF Rr [pEsr <br />PI ANS ArPROYFD IR' <br />DATE (�' ` <br />CITY -OF EVERETT <br />LOCAL SALES <br />TA%CODE IS 3105 <br />rRMIr. MYxINs <br />TOTAL <br />