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�----- ► <br /> APPLICATII.N rOR CONSTRUCI .ON PERMIT `•`'''«'t ��-� <br /> TO BE COMPLETED IN INK—PLEASE PRINT � ; <br /> �nvor <br /> everett HEATING SYSTEM: U GAS J ELPCTRIC :J � <br /> BUILDING DEPARTMENT � <br /> 255-8810 <br /> � r �" DEMOLITION COMBINATION (�BUILDING MECHANICAL PLUMBING SIGN <br /> ,•;+� <br /> t�7 y O�»�CR MAR AD�RESS CItV IIP i'HONE �.' <br /> � t ry �. <br /> x ` <br /> /�r-� - ,, ti� �ev iir� .�. /G6' SF.orr�� .5�/Eil.-� � � �a iii�- <br /> �C � � 1CIUNT � MAIIAJDRE55 pTY ZIP PIqHE — �`�` <br /> : I � <br /> ` ��F, <br /> y� � nRCHfiEGTOfiDESN'iNER M�ItMDRESS CITV 21P PfqNE . . , � <br /> k n <br /> H 70 <br /> O r�L O G[N[R/1G/ONTRACIDF M��RjADDRE55 CIT' n- 21P PMONE LILENSEI <br /> � v~i M ( / ., ..i„4 Lc+��.�` /�f�n._.,y�•n /UX ��Lc^�7.��..5%�C� l//i/�,�i.r. /a/ �P <br /> y `� IAECHANIG CONTR�CLOB M�IL�DORESS ��T�' Z�P PIqME � IiCENSE/ <br /> [s1 p <br /> � H � �WMBINGCONtRRCTOfl MMLADDPESS CIiY DP VIqNE LICENSE� . ��- ,� <br /> ��g <br /> L�• O GLASS OF WORN ' <br /> z y� NEW � . ADDITION ALTERAiION � REPAIR _ �: DEMOLITION WOODSTOVE/FRPLINSERT � �. BUILDINCaRELOCATION <br /> �� <br /> �� /�/� /� CONTAC'PERSON�ND PHONE NO '�-S'(��� 7 //L <br /> �y y C(NlTRACT PRICE OF WOHN [l(/ !/V� 2l^-' --- -� / I ' /!O �� 7 <br /> �..� DCSCP.iBE WORKANO50UAf1E FOOTAG� NVOLVEO <br /> O❑CtA J _ ` ,� , _ <br /> 3�e!ts1�," raprpSEo SEOFButDhro q I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Z H C/) ��L/Rf L /COrI F �YI/7lD'�P � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.All <br /> y �y irS�LDESCRIPTKKIOF PROPERTY ISHOWHBEIOW ORRTT�CNFOURCOPIES� PROVISIONS OF LAWS AND GRDINANCES GOVEPNING THIS TVPE OF <br /> WORK WILL BE GOMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��* e�aK � NOT. TNE GRANTING OF A PERMiT DOES NO7 P�ESUME TO GNE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRU�TION OR TH'c <br /> PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEF OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE I <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. � <br /> SiGNAiURfOFLONT6ACiOROP�UiNO�ILE�AGENi DATE <br /> ' Z� <br /> naaFctaooREss ���j�✓ .���f' 1 Cs .� ��� ��_ � <br /> y� , ✓ q7�p q��v�i�pNP'QTvpU5ME55liGEN5EN0 RNDBOSMESSNm,1E <br /> d �/YlL'/2 [�(!/�1li <br /> __ PLUMBING MECHANICAL <br /> � NO. TVPE OF FI%TURE OR ITEM FEC NO. TYPE OF EOUIPMENT FEE <br /> �C', � WATER CLOSET(TOILET) A��A/HNDLG UNITS—H.P. <br /> � i BATHTUB FORCED AIR SYSTEMS—B.TU. M E.A. — <br /> LAVATORV(WASH BASIN) UNIT HEA7ERS--B.T.U. Id <br /> SHOWER CLOTHES DFV[RS <br /> i �-' KITCHEN SINK 8 DISP VENTILATION FAN _ <br /> � DISHWASHER RANGE HOOD <br /> � LAUNDRYTRAY WATERl1EATER <br /> � CLOTHES WASHER WOODSTOVE <br /> I � URINAL METAL FIREPLACE 8 CHIMNEV <br /> _� DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPIKG <br /> =1 ' ROOF DRAINS--RAINI.EADERS ExHAUST FAN <br /> . SINK(SERVICE—BAR,ETC.) <br /> � ��•� — <br /> �� <br /> � SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIi S <br /> �1—1 TOTAL FEE $ TOTAL FEE b <br /> FOR OFFICE USE ONLY: <br /> FRONiSETp�CN F qSFiAAGK SIC�ESEipAGK PUNQ GNNUTA�[R FEE REGEIPTNO <br /> ' �/ 7�/2 . � , 9-'� ,532 .� <br /> u�Eza+= �r��[n J vncnr��rte FEES ALUATION FEE <br /> C �00 � � euaoiNc /oo oo� �?9 L,�_o_ <br /> IYPFO�GONiuALLOWABIC ivl'COIU49�G1�ti ocrnr��M� q�qpx6tvicuxn5 <br /> _ f\/ , � �,/ cnou> p�UMBING <br /> p �/ V <br /> SREOFBtDG. NO.OFSTOPi[5 BASEMCNT MECHANICAL � � <br /> J—_ <br /> OCCIIPRNCYLOAD FIRESPRNKLERSRWD HEIGMTLIlArtATION A�DITIONALPLANCHECK <br /> 1 <br /> OTHEF <br /> t�[�SON Poi1;PRMNLEPS - <br /> STATE BUILDItJG SURLHARGE isTj <br /> �u-,�Ke er run n�aaoveoer CITY OF EVERETT PUBLIC WORK$ '�T— <br /> LOCALSALES <br /> ��I TAX COOE IS 3105 TOTAL � ��G <br />