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everett ' <br /> APPLICATION FOR CO�ISTRUCT►JN PERMIT � <br /> ��E�,���� TO BE COMPLETED IM INK—PLEASE PRINT � � <br /> aTv oF � <br /> eve rett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � � <br /> BUILDING DEPARTMENT <br /> 259-8810 � <br /> DEMOLITION I COMBINATION X BUILDING _-MECHANICAL PLUMBING SIGN I <br /> yy OWNER M�RAUDRE55 CRY ZIP VMONE I <br /> {{[�L0 � ^"� l(YI �,CO G�3`>� Nn� rf �E��� 2��� <br /> p y� iEN��J 1MM1MDPE55 C�TY ZW PNONE I <br /> y �3 N I��OI?i �3` .. - I <br /> H Cy ,� RRCHiT[CTOF�ESIGNER M�ILADDRE55 CiiV ZW �MONE <br /> H Y Hn <br /> K �7 'A GENCRRlGON1RACT09 M�RMDi1E55 CITY 21F PHONE LICENSE• <br /> � N � � �lsi /2ol¢ZaZ"STr� ,�-r�-�/" !��-e� 334-1d¢_H�e�T��q�• <br /> � MECH�NIGALCJNTRRGTO MRIL�O�HE55 CIiY $IP PHONE LIGEHSEI <br /> O� n � PLUMBMGLpfiRRCiUN ��I�ODRE55 C�TM 21G P11pNE LICENSE• <br /> � � <br /> �"� CUSSOFWORK <br /> � H . �. NEW � . ADDITION ALTERATION �.�I REPAIR ' , DEMOLITION �.� WOOOSTOVE/FRPL INSERT '_� BUILDING RELOCATION I <br /> M y CONiRGTPERSONANDPHONENO. <br /> N ��, 3 .� <br /> ~ GONTR�GT PRICE O�WORK <br /> C N �ESGRIBEWONNANDSOWR[FOOiA MVOLVEO eNA iWrZJtu <br /> I� � �y v�, /�/l�0/f�b �J <br /> O tn PNOPOSEDUSEOFBUIlOiNG I HEFEBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> �c n�oescaivtior+ov ao�r� Howr+ee�owoa nrtacH rour+covies� PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TVPE OF <br />. � i7,�„i WORK WILL BE COMPLETED WiTH WHE7HER SPEr,iFIEO HEREIN OR <br /> LOT BLOCK �{�J oF _��i/ �L u NOT. THE GRANTING OF A PERMIi DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PfiOVISIONS OF ANV <br /> ( ( (�C �� OTHER STATE OR LOCAL LAW REGULA?ING CONSTRUGTION OR THE <br /> PERFORMANCE OF CONSTRUGTIOtJ.THAT I AM AUTHORIZED BV THE <br /> 3 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOP WHICH <br />, ��✓ APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />. � --` �� ��� . CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � SIGNAiUFE OF CONLPRCTOR OR AUTHORIZLD AGENT DATE <br />. P�T�D�PES-�!�� -�+�/ <br /> �� � ���,y��� %�� � APPLICR��iN�ENS[NO.ANOBIISMESSN� E • <br /> � � � �iV�}7�l1' /J/ l.(�-- Gv r <br />� �� PLUMBING MECHANICAL <br />� � NO. TYPE OF FI7(TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> il • A/C--A/HNDLG UNITS—H.P. <br /> WATER CLOSET�TOILET� <br /> �� BATH7UB FORCED AIR 5`!STEM�B.T.U. M E.A. <br /> i !�I LAVATORV(WASH BASIN) UNIT HEATERS—B T.U. M <br /> CHOWEq CLOTHES DRVERS <br /> � KITCHEN SINK 8 DISP VENTILATIOIJ PAN <br /> 1 — <br /> '�� DISHWASHER � RANGEHOOD <br />� , I �+ LAUNDRV TRAY � WATER HEATEF <br /> CLOTH[5 WASHER WOOD STOVE <br /> . . URINPL ' METAL FIREPLACE 8 CNIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> , I 1 1 FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVEIJTEFlS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> � � <br /> SINK(SERVICE—BAR,ETC.) ' <br /> �t�� � � <br /> I � <br /> i � <br /> � 1�' SUB TOTAL $ ; SUB TOTAL $ <br /> _�� PERMIi $ PERMIT $ <br /> - TOTALFEE $ TOTALFEE $ � <br /> FOR OFFI:,E USE ONLY: <br /> �iPO4T51 ACK REARSETB N 510[SET� LN PLANCHECNNUM?sA fEE AEGEIPTNO. <br /> � a ^ <br /> usE za+E LOT FPER wcnnr srtE FEES VALUATION FEE <br /> �Z ^ • n� BUIL�ING �u OJJ � i <br /> TYPEO�CONIS.U,�I/OWPALf TYPEOFCONSI.ACTU�I o[cur�xa NodbNFuixtuNrts � <br /> V - 'v �� N pW� P�UMBING <br /> SREOFBlM3. NOAF6TORIES BRS[MENT MECHANICAL � <br /> OCCUPANCYl0A0 FIRESPRNNLERSREO'� MEIGNi/Li�M'i�lAilpN AOOITIONALPLANCNECK / � i� � <br /> 7V/ OiHER <br /> PEASON fOR SPPINK..ENS <br /> STA�E BUILDINO SURCHARGE i 5(J <br /> INiANEBY rur+s � r�+oveoer CITYOFEVERETT PU�UCWORKS <br /> /�� LOCAL SALES <br /> .� TAX CODE IS 3105 TOTAL ',1� <br />