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�"` �� <br />' APPLICATIOr�I FOR CONSTRUCT �ON PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />I-1 DEMOUTION I l COM8INATION fl BUILDING I� MECHANICAL r l PLUMBING , SIGN <br />PROJECT ADDRESS <br />�Ql�'l R 0('X�.GCIa_C�I C,.11/1 /�-r Qd �, ., � <br />��� <br />� 6O •-b29 •- <br />. _ _...... ............. �,nr vir rNorvE � <br />GENEMLCONTRALiOR MnILRDURESS CiIY 7iP �IIONC ciniEl.ICENSE� <br />MECIIANICALCONTRA�TCR MRIIAppqFSS CITY 71t' PIIONG STATELICENSE� <br />PLUMBINGCONiRRf,TOF M/.IIADORE55 CI�Y ZIP pNONE STAIEUCENSE• <br />WORIt <br />SO��ARE <br />L <br />LEWL OESCRIPTION OF PROPF <br />ior eixK <br />rexio. <br />INVOLVEO <br />�� <br />OYM BELOW <br />_ or_ <br />CONStRUCTIpNIO�NLENDER,ADORE55.TElEPMONENUMBER <br />PLUMBING <br />NO. TVPE OF Fl%TURE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK R DISP <br />IAUNDRYTRAV <br />CLOTHES WASh <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />SINK (SERVICE — <br />FOR OFFICE USE ONLY: <br />fRONTSFTPFCN RE�R SF.TBACN <br />USE ZONE <br />IUUREA <br />HEATING SYSTEM: �GAS �1 ELECTRIC I l <br />CONTRCT f�[RSON 4ND PIIONE NO <br />I HEREBY CERTIFV THAT I HAVE READ AND EJ(AMINED 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 WH[THER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE 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 18.27 RCW AND 296200 WAC. <br />x � � �u-anv+" 7� / <br />SIGNATURE � T� <br />CITY OVSMESS UCENS[ NO <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMENT <br />� <br />' A/C—AMNDLGUNR'S—H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />' UNIT HEATERS — B.T.U. M <br />i CLOTHES DRYERS <br />� VENTILATION FAN <br />i RANGEHOOD <br />� WATER HEATER <br />WOODSTOVE <br />� METAL F�REPLACE (WOOD BURNING) <br />! FIREPLACE INS[RT (WOOD BURNINGI <br />i <br />SUB TOTAL $ ; <br />PERMIT S <br />TOTAL FEE $ � <br />SIDE SE70�CN <br />HEICMT LIMITqT10N I NO OF UWELLING <br />IINIIi <br />LOa[J <br />:'M <br />vnr,nrur sirr <br />tIVES I' NO <br />S12E Of OLD(iRl <br />lIYES I1 NO <br />CITY OF EVERETT <br />LOCALSALES <br />TAX CODE �S 3105 <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />PIANf.11f.CNNl�.ff1�J f[P <br />!O yJ <br />!- <br />FEES <br />ouunir+c <br />PLpAI(iING <br />M[GI�NICPL <br />��p111pNA1. PI AN C��f CN <br />on�rn <br />srm� nuiioiHa sunr.rmnoe <br />rum �c wonHs <br />TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE $ <br />RECfIPi NO <br />FEE <br />