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APPLICATIO�� FOR CQNSTRUCTi.�N P'ERMIT �'`'`'"�" <br /> ; TO BE COMPLETED IM INK—PLEASE PRINT � <br /> everett HEAANGSYSTEM: UGAS ❑ELECTRIC ❑_ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING : MECHANICAL �LUMBING SIGN <br /> 1-i pyM q M�0.WDNE55 CfTV 21P CHOHE <br /> � � y ���Ir� �s� .�e' ''�Fm�fetl �� P„� a�P- Gv�I <br /> C H �tN�Ni MMLADDFE55 <br /> � H N <br /> � � = M1RGHrtEQ OF DESIGNEP MRM1 A��AG55 GItV Z�P P��E <br /> y �+ <br /> K <br /> O Q O GENCP�I TRnCT MAR ROORC55 CfTV 21F PHONE LICENSE• <br /> '` y � ���" �% ��nlS� .2�� 4,{ 5� �JeE�// 982� �35��a/� _ <br /> � <br /> Q Z � NFGHRNiGRL 'R�GTOH M�ILApDRE55 LiTY ZIP PHONE LICENSE� <br /> b7 K <br /> y <br /> '� n P� BMGCONTRRCIOR M�dADDRE55 GRY ZIP PNJNE ��GENSE� <br /> � � � . n,��� ��� �� ,,��' ti 9Sa� �R�.9�PT i�e� <br /> � y � C1P550F WORK . .. <br /> F, y NEW � ADDITION � � ALTERATION .'', REPAIR �, DEMOLITION . WOODSTOVfS'FRPL INSERT _ BUILDING RELOCATION <br /> y CONTRCT PERSON RNO PHONE NO <br /> H <br /> O N r.�N"nnCirniCEOFwor+K <br /> � ro r ��c��niBEWORK�lASOU�AEFO0i11GEMNOLVEO <br /> o � J-�r�oseou���mo I HEREBV CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPUCATION AND KMOW THE SAME TO 6E TRUE AND CORRECT.ALL <br /> �t�.m ocscFivnoNOF PnorEarv�s�r�+eE�owOn�n�CHFalnCoviE61 PROVISIONS OF IAN/S AND ORDIIJAIJCES GOVERNWG THIS TVPE OF <br /> WORK WILL BE C0�IPLETED WITN WHETHER SPECIFIEU HEREIN OR <br /> i,,� g�,pcn oc NOT. THE GRANTIMG OF A PERMIT DOES NOT PRESUME TO GIVF. <br /> — AUTHORITV TO V�OLATE OR GANCEL THE PROVISIONS OF ANY' <br /> C-4ER STATE OF �OCAI LAW REGULATING CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNEF OF THIS PROPEFTV TO PERFORM THE WORK FOR WHirH <br /> APPLICATION '.S MADE AND I COMPLV WITH THE TPT[ <br /> CONTRACTORS�AW 1827 RCW AND'296200 WAC.�/ �� <br /> StGNRTUREOFCqNTNALiORORnJ1N0`Z[f1CGENT OATE ��// <br /> n m.�, i�it/ /•r/(, N <br /> X i.��, � r� � <br /> -� �%�,llf-� �E./�inT�� <br /> i � PqOJF6iId"d�RES � y�,qMSQTYBU5ME55UCEN5FN� 4NDBU�'NESSNAIAE <br /> �� / <br /> � . PLUiABING MECHANICAi <br /> � �. NO. 7YVE OF FI%TURE OR ITEM FEE Np. 7YPE OF EOUIPMEN7 FEE <br /> VlATER CLOSET(TOILET) A�G-0.'HNDLG UNITS—H.P. <br /> f��1 FOR�ED AIR 5`.'STEMS—B.T.U. M E.A. � <br /> BATHTUB <br /> w� LPVATORY(WASH BASIN) D UNI f NEATERS�—B.T.U. M � <br /> T <br /> ' SHOWER CL��THES DRVERS ' <br /> � KITCHEIJ SINK 8 DISP VF.NTILATION FAN � <br /> f�� DISHWASHER RANGEHOOD <br /> ' �' LAUNDRV TRAV Y✓ATER HEATER <br /> CLOTHES WASHER � NOOD STOVE <br /> :;AINAL ' METAL FI(�EPLACE B CHIMNEV <br /> � DRINNING FOUNTAIN FIREPLACE INSERT i <br /> �1 ' � FLOOR OFlAIN HEAT PUMP �_ <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> � I 1'�' SINK(SEFVICE—BAR,ETC.) � <br /> � � <br /> I <br /> i — <br /> I �` <br /> f 1,rI. SUB TOTAL $ /O — SUO TOTAL S <br /> \ PERM�T $ /A — _ PERMIT $ _ <br /> TOTAL FEE S ,'aD ' " TOTAL FEE 5 —T <br /> FOR OFFICE USE ONLY: <br /> fRONiSEtBRCK �[APSEiBACK 9DESEiBRGK PUNCHEGNN�UBCl1 f[E �[CEIPTNO <br /> USE ZONE LAT�REA v�cu/7 sire FEES VALUATION FEE „�_ <br /> BUILDING <br /> tYPE Of COHfS.RLLOW�BLF TVPE M CONSI.�LTU�L atan.M[r No d ow[wvG ux.�s <br /> cnw. PLUMBING .�J ;n� <br /> � SIZEOFBLDfi. IIOAFSTORIES BASEMENT �!ECHANICPL ' <br /> t___ <br /> OCCUGANCY LOAO FIRE SPRNNLERS AEOD NEIGHT IIMR�iION ADDItIONAL PLAN CHECK <br /> OTHER <br /> _ —�_— <br /> R[ASON FOH SPHINNLENS <br /> STAiE�UIIDING SURGNAfiGE <br /> nanKeov r�nNsnrnnoveoev CITYOFE4ERETT PUBLICWORKS <br /> LOCAL'iALES <br /> TAX COOf IS 3105 *o'>� 3� ; o.� <br />