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APPLICATION FOR CONS't RUCTION PERMIT � <br />TO BE C���LETED IN BLACK INK—PI.EASE PRII <br />BUILDINO DEPARTMENT �— <br />259•BB10 <br />O DEMOLITION ❑ COMBINATION <br />wa �oonE e <br />��� � �C.�u �r� <br />tE� wt �oon cs <br />ARCM�CjORDEBqqER 1AAILADOqE88 <br />�l i � <br />aaarw.cam�cron wu�oonEea <br />.., <br />� n r,r {: , <br />��\ 1 <br />�au oeecnivran a rnovi <br />l07 BLOCK <br />r,vicn rNc i.o. Nu�eaa <br />CdMTRUCipN IOAN IENDE0. ADDREBB. <br />NITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRV TRAY <br />FLOOR DRAIN <br />BACKFLOW P' <br />FOR OFFICE USE ONLY: <br />FIIONilE1MCK RFM SFT <br />UBE 20NE l01 �REe <br />rv►1 a cpur. �a. ot sr <br />iR! Or �L00. FIRL BPRR <br />rrtu� or <br />� <br />HEATING SYSTtM: <br />SUB TOTAL f <br />PERMIT S <br />TOTALFEE S <br />wwe �rri+ovco er <br />D�TE <br />❑ BUILDING <br />z ���� <br />CITv <br />�I ELECTRIC �J <br />21P <br />21P <br />CONTACT PER$pN AN� P110NF NO <br />P110NE <br />P1qNE <br />P1qNE <br />PNpNE <br />❑ PLUMBINO <br />BT�TE <br />O SIGN <br />�i�_c,` <br />i HERtB1� CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CARRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNINp THIS TVPE OF <br />WPIEB� WOP'C WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR TNE <br />PERFORMANCE OP CONBTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPIY WITH THE BTATE <br />CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br />x ����,�-4� ����h�.���/93 <br />5(1M�IVP[ p/�II <br />� il v pipM1511 C[ My �q <br />MECMANICAL <br />FEE N0. TVPE OF EOUIPMENT FEE � <br />FORCED AIR SVSTEMS <br />UNIT HEATER$—B.T.U. <br />METAL FIREPLACE I <br />FIREPLACEINSERT <br />HEAT PUMP <br />61DEBETBA�R iUNCNEW NUMBEq FEE <br />!l��y <br />v�c•n* s�re 'FEES <br />�� VES .. NO BUilOiNG <br />OCCUMK� MOtlO'Mll�YfiVM�ll <br />��� PLUMBiNO <br />BASEMENT MECHANIC�L <br />❑ VES ❑ NO <br />NEqNT LMIITATqN ADDITIONA� PUN LMECK <br />OTNEH • <br />STATE BUILDINO SURCHAROE <br />CITY OF EVERETT PUBIIC WORNS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTAL f <br />PERMIT f <br />TOTALFEE S <br />a <br />fl <br />