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R"� <br />APPLICATI4N FOR CONSTRU�Tlu�`�N PERMIT <br />;neEvergreon TO BE COMPLETED IN R�K—PLEASE PRINT � <br />:ITY OF <br />everett <br />BUILDING DEPARTMENT <br />259•8810 <br />DEMOLITION <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ _ <br />COMBINATION BUILDING <br />everett � <br />� <br />� <br />� 1 SIGN <br />9WryER �A�IL�DDNE55 Q7V ZIF PMONE <br />,�ri� N�v r,u i s s 7 g/G� /3�i�F�� s�.ac�E Ca��,��7 "� s3 8/6 y <br />�F.N�Ni MNLAODRE.S CIIY 21P PNONE <br />nfIC1aTECfORDESqNER MMLAUDRE55 CITv ZIP VNONE <br />fiENERAICONiRACTOfi • M�ILAD�RE55 CITV ZIP PIIONE UCENSEI <br />�AECNANIL0.CONT1UCiOf1 411RAODfiE55 CIIY ZIP VIqNE LICENSE/ <br />'�T//lUf��7 lU9i7G'n //c%J7Fr ��//U .5�il� si FY.�f�EiT Ir��[�/ ZS/`,533/ ,�bRTyu�H/a3RZ. <br />PIUMBINO CONTRACTO� M�K AUURE59 CI7Y 21P PIqNE LICENSE / <br />f.l 5 O% WORK <br />NEW � -.�D�TION ' A'_TERATION <br />iK) <br />o ._.. � _ <br />lEOAL <br />lOi <br />PRICE OF WORN L V <br />NORK�NDSOU�REFOOT�OE <br />REPAIR I 1 DEMOLITION ��� WOODSTO'iE/FRPIINSERT L7 BUILDIPI(iRELOCATION <br />CONT�C7 PEfISON RIO P��ONE NO <br />PRO�E�T� ISNOWN BELOW OR AITnCH iOUN WPiE 51 <br />BLOCR Of ._ __ <br />. <br />eoonEss <br />�Fi��r� ; �,�nf� Fi <br />M81126 <br />� TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOIIET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />FLOOH DfiAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONiSCiB�CK RE�R: <br />USE ZOHE LOT Af <br />IrvfOf[ONISAILOW�BI[ IVVF01 <br />SIZE OF OLDG NO (6 <br />OCCUPANCVlOAD fl(�ES <br />RE�SONfOPSPRINNIE�S <br />INf�NE Bv �1�N5 <br />I HEREBV CERTIFY THAT I HAVE READ ANO E%AMIpED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PFOVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETcD'i'TH WHETHER SPECIFIED HEREW OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AN'! <br />OTHER STATE OR LOCAI LAW REGUI.TTIN� CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THF <br />OWNER OF THIS PROPERTY TO PEfiFORM THE SYOHK FOR WH�CIi <br />hPPLICATION IS MADE AN� I COMPLY WITH THE STATE <br />CONTRACTOFlS LAW 1827 fiCW AND 296200 WAC. q <br />SIGN�TUREOF�CMlTRALIOROR�UTHORIZEO�OENT U�TE /��I9/ <br />X �+� /' %%?i'�'t ,/���o*� <br />APPLICANTSCIT USINESSUCENSENO�ANDBUSINESSNMIE <br />NO. TYPE OF <br />NC—A/HNOLG UNI <br />FORCED AIR SYSTI <br />r UNIT HEATEflS—B. <br />CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANOEHOOD <br />' / WATER HEATER <br />r WOODSTOVE <br />METAL FIREPLACE <br />FIREPLACE INSERI <br />� hIC•AT PUMP <br />; Q GAS PIPING <br />� E%HAUSTFAN <br />TOTALFEE E� <br />sioe sera�cK — <br />V�GANT SiIE <br />IWl URunw• xndOwlWMcuVni <br />pMlr <br />� O�SCMfIlt <br />snroo r�e�mauuirena+ <br />•PPROVELB� <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX COOE IS 3105 <br />T.U. M E.A. <br />8 CHIMNEY <br />E <br />FEE S <br />PL�NCHECNNUMOEA I FEE I RECE�PTNO. <br />BUILDINO <br />PLUMBINO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />S1ATE BUILLINO SUPCHARGE <br />PUBLIC WORNS <br />iOTAL <br />� <br />