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APPLICATIOi: FOR CONSTRUCTIJN PERMIT �'`'t«'« <br />rneE��.�„ TO BE COMPLETED IN INK—PLEASE PpINT � <br />CITY OF <br />eve rett HEATING S'/STEM: GAS `J ELECTRIC U ] <br />BUILDING DEPnRTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING ICMECHANICAL �'VLUMBING SIGN <br />TENANT �-Y MAL�DDRESS <br />5'�I.b'll� . <br />11qCNREGTORDE5IGNER M�RAO�HE55 <br />; <br />, GENERQ GONiNALIDR MMl �ODRESS <br />� MECH�NICALGONiPAC10R M�ILApDRE55 <br />�OV�IU.k'r,�-- �lln N <br />'. PLUM0ING LONTRACTOR MML ADDRESS <br />ciTr <br />� <br />��,Y <br />CITY <br />CI7V <br />CITY <br />� <br />CIiV <br />ADDITION . � ALTERATION REPAIR <br />QESCRIBE WORM ANO SOU�HE FO01 <br />I Y1� I i-�u�614 � <br />PROPOSED USE OF BUILD111G <br />'�i � <br />�ec�� oesc � riori a raorEan � <br />LOT BLd:R <br />1# �C�Q_ <br />INVOIVED <br />BELOW OR AiT�GH iWR GOPIE51 <br />OF <br />� PR0.1ECi�DDNE55 <br />7 <br />� PLUMBINO <br />� NO. TYPE OF FIXTURE OR <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />IAUNDRVTRAV <br />CLOThiES WASHER <br />URINAL <br />DRINY.ING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAMLEAC <br />SUB TOTAL E <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFICE USE ONLY: <br />FRONTSEiB�LK RE�RSETBALN <br />SIZE OF BLD� NO OF S70PIE5 <br />OCGUPMlCY IO�D FIRE SPRNKIER: <br />PUNS �PPROVE 0 OY <br />J <br />21P <br />� <br />ZIP <br />ziv <br />ZIP <br />21P <br />3 <br />21P <br />DEMOLITION <br />CONT�Ci <br />PNONE <br />� <br />PNONE <br />a�wne <br />PNONE <br />PNONE <br />WOODSTOVE/FRPL �NSERT <br />AIID P110NE NO <br />lt�'r} i�:P%A t °�' 1 <br />LIGENSE I <br />LIGENSE � <br />� <br />UCENSE� <br />BUILDINfi RELOCATION <br />I HEREBV�ERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF lPWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br />OTHER STATE OR IOCAL LAW REGUUITING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I FM AUTHORI2ED 8Y THE <br />OWNER OF THIS PROPERTV TO PERFORM TF1E WORK FOR WHICH <br />1PPLICATIpN IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />SIGN�TUREOFCONTR�CTORON�IITHORIZEDAGENT D�iE <br />,a-�9-9� <br />L 1Jl.f ��-��'�. UV�LI W� jQ3� <br />�PGLM.ANiSC 'BUSMESSIIGENSENO�NDBU51ME55N�ME <br />A/C—A/HNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHiMNEV <br />FIREPLACE �NSEHT <br />HEAT PUMP <br />SUB TOTAL S (c O ' <br />PERMIT $ / <br />TOTAL FEE S �}"` � ' <br />RECEIPTNC <br />�S�/3J <br />V�C�NTSRE FEES VAII <br />BUILDING <br />tkCu>�Mv MOf/bMiuN�:uyns _"__—_-_— —___—__ _— _ — _..__ <br />°�"�' PLUMBING <br />BASEMENT �ECHANICAL <br />iEIGNT IIMItATqN ADDITIONAL PLAN CHECK <br />_ OTMER <br />STATE BUIIDMG SURCHAqGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOl'AL <br />7S�:o� <br />0 <br />