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APPLICATII�.N FOR CONSTRUCI rON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STRCET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILOING ❑ MECHANICAL ❑ PLUMBING O SIGN <br />PROJECT ADDRES3: <br />tEN�NT MMlR1pPf55 f.ilY )iP pnp�E <br />�� �'IIV�iI <br />-�A1 i <br />MECNANICQ CONTR�CTOR M111 �MME55 CITY IIP PIIONE ST�if UCFNSE • <br />PIUMBINGCONIRAf,id1 M�IL�0011E55 CI:Y jIP pIqNE SGfELIGENSE� <br />/J '/ � �n <br />�ncsca�ee waoc �Ho sa�u�r voouac �Hvaveo <br />-� ��(��'� ��I'(a� <br />rnaoseo vse rK euiara <br />ieaa oescmrrmr+ov vrarEnrv �s�avm aciow an �n�.cN �wo canes� <br />�ot e�a�K a� <br />PNICEI TM I D HIIMB[F <br />� 57�$�00�-OUI-CX�D7 <br />fANSIRULTqN LOAN lEHOER.110011E55. TEIfMN}1E NUAIRER <br />PLUMBINO <br />NO. TYPE OF flMURE OR ITEM FEE <br />WATEH CLOSET (TOILET) <br />BATHTUB <br />UVATORY (WASH BASIN) <br />SNOWER <br />NITCHEN SINH 6 DISP <br />OISHWASHER <br />LAUNDRY TRI1Y <br />_ CLOTHES WASHEiI <br />URINAL <br />DFINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK ISERVICE — BAR. ETC.1 <br />SUB TOTAL f <br />PEi!MIT f <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTFEfNAC1c pEu15FiB�CM� <br />USE IONF ^ <br />�_ <br />HEIUIII �IMITRIOM— � <br />iIRE SP81NNlEN REO'U <br />iot �nEe <br />�3ooc� <br />NO Of MIEIIINO <br />UNIIS ' <br />O(:CUP1NIlO�U <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />ccx1r� r rrns �Nn r��orrt rro <br />I � /1�Gn,� > /1/..- l�Q _ I �I <br />I HEREBY CEHTIFY TNAT 1 HAVE READ AND EXAMINED THIS <br />APPI.ICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORCINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE ORANTINQ OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV <br />OTHER STATE OR LOCAL lAW RE�ULATINCi CONSTPUCTION OR TME <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOfiIZED BV THE <br />OWNER OF THIS PROPERri TO PER�URM THE WOR:I FOfI WHICH <br />APPLICATION IS MADE '�D I C061PLV WITN THE STATE <br />CONTRACTORS LAW 1827 RGW AND 298200 WA <br />x�JCx/ tu.��� 1 V 1� <br />SI�NAfU11E DyE <br />C11Y BUSINESS IICFNSC NO <br />MECHANICAL <br />N0. IYPE OP EOUIPMENT FEE <br />N(: —NFINDLQ UNfT3 <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />WOOD STOVE <br />METALFIREPLACC <br />[�71Ytll�li[el <br />SIOESFIB�CN PI�NCIICCNNUMNfO <br />S � �/" � <br />v�c�N� sni- EES <br />❑Yf5 �NO pUIl01N0 <br />S�IE O! BlOfi/11 <br />�j�llo SF. GPRK+E ^���uniHa <br />l�SFMENI MF1:11.1HIC�I <br />❑YFS HO <br />— �OOIIIONq M�NC��fClt <br />on�[n <br />; 51�1E OUqIl�MO SIIIN:rUilf.E <br />er CI1Y OF EVERETT r �iniir wom.s <br />LOCAL SALES ------ <br />TAX CODE IS 3105 tou� <br />SUBTOTAL f <br />_ PERM17 f <br />TOTPLF:E f <br />� ) <br />rrry,?1 nar. <br />U " / (� , <br />