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APPLICATIOR FOR CONSTRUCTAN PERMIT <br />�* <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET IT EVERETT, WA 98201 • (425) 257-8810 <br />❑ DEMOLITION ❑ COMBINATION , BUILDING ❑ MECHANICAL PLUMBING ❑ SIGN <br />PROJECT ADDI <br />ria IP 1�iTF 1= <br />L[NANi uMI 4IME55 GO' ZIP vWNF <br />pPS(67W ENLILn <br />MECHANICAL CONGIACIOR MAIL AOOBFSS CIN III' PINOF SIALF LICENSE <br />-pESlat'l '3L)I(d7 <br />PIUMIINGCONWACtOR MAILACg1ESS Clh ZIP PHOVF SiA1E 1ICFHSFF <br />4 2bn 4�- LiJs 33 3 S7rJZ <br />colluucT PdcFGAWp11K <br />IJ A� r I MPRofLf E1 3T �Fl <br />Yf <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC C <br />OESCRIPF WORNA�SWARE EOOlAGC 111VU1VE0 <br />� <br />CONTACT rfR$ON AND PNONF NO� <br />ZZ- <br />lom A65G77 `/�� lnyo Oi3s <br />po-14,1 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW IB.27 RCW AND 296.200 WAC. <br />X�<' ( /AL 'r'i.. ✓I -�N-7 J <br />PIN)IYIifO USE OF BUlldlF'J <br />C� LJI S T� <br />LEGAL�IIO TY ISNOWN BEEOMOR ATIACN EYIO CO%ESI <br />LOT BLOCK Or <br />_ <br />l <br />PMCEL iFJI l O NUMBER <br />CWSLRIICFIONLOANLENCER.AOOPESS. TEIE%IONE NUMBER <br />S$GNAGAAE DATE <br />CITY BUSINESS LICENSE IND �ry <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 />0 <br />A(C—MINDLG UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK S 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 />—FIREPLACE <br />DRINKING FOUNTAIN <br />INSERT (WOOD BURNING) <br />FLOOR DRAIN <br />GAS FIREPLACE <br />BACKFLOW PREVENTERS <br />GAS RANGE <br />1 <br />SINK (SERVICE — BAR. ETCWs <br />) <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE f <br />FOR OFFICE USE ONLY: <br />(D qt'c. SL <br />I RONL VTP M <br />RFAPSFIRAC.K / <br />to <br />SIM SFITIOCK <br />PIANCIIECN HUNTER <br />7 <br />fFF � <br />RFfFIPi NO <br />usf 1 <br />Z_ <br />Lmy1FA i <br />( <br />NACA SIM <br />.Fs D rn <br />FEES <br />VALUATION <br />. <br />BTfldw: <br />Q C 1 Ei <br />/- <br />10 W& )ai <br />- <br />NfIC.N11Iv AFNW <br />I <br />1 OILOf UW LING SIZE <br />II <br />OF <br />[O> <br />%NMI11Nf• <br />F <br />m <br />CCCLIP'ANf.Y <br />NO I <br />Jill <br />WMSWbtS <br />oZ <br />QCUPANLI AO <br />3 42 96 <br />14N1 <br />4FGMN(At <br />ApdulNJN %ANGNCK <br />nPLSMIyIN(nLERREaD <br />lJJ <br />RF AS <br />UnumT{t1J <br />U YT <br />OTIKR <br />RPE AURM PEG'O <br />.1—l', <br />'^ <br />IIAII FILAIDING SIIPCIIARGE <br />rnrn <br />I�vl <br />'lf coegi <br />V —N <br />rInN�S Ar`rnovFG PY <br />�L <br />DALE l a <br />CII Y OF EVERETT <br />LOCALESALES <br />TAX CODIS3105 <br />rNnur. NVRKS <br />' <br />--�— <br />TOTAL <br />--- <br />/0 1� '� <br />