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� � iAPPLICATIO.. FOR CONSTRUCT� `N PEFiMIT �� <br /> I , TO BE COMPLETED IN BLACK INK—PLEASE PRINT `�T' <br /> V <br /> - -- — _ _ _ - - -�i - <br />� HEATING SYSTEM: J GAS J ELECTRIC J __�Y^t—___--.-_ I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ✓BUILOING MECHANICAL PIUMBING SIGN <br /> owr�r:r, Mnaaooaess ���y Z1' """ <br /> E✓E � �V FqNtiRti f��M �CEMfTr'T�l �Sb�{d�_oadw�Q�2U,� 2S� - 2 Z �5� <br /> iENANT I/,til ADONCSS—T GITY 7 ' <br /> �weler <br /> ARCMITECTOqDE51GNER 1dAI�ADDRL55 GTY 21P PMONE <br />, /��5.>/6N D�SIGIJ 2'//fl•< <ali�eiNr1 �+✓f, �✓rn1� 9.42d/ 15�2 -�J�.dp <br /> GENCRALCJfITRPCTOR MNL�DDRE55 CITY ZIP PNONE SV�TCLiCENS[d <br /> �es/�PNp�Prren�f'c,vst JS'/� T�n� bNrf�,YlD�,x13.��E�'t�" `iyZ�� 3r3'e22S �ES�FC�1`o�/U.�_ <br /> IAELNI.NiGALCOHiRARGR IAAILADDPE55 CiiY ZIP �f�J!JE RGICLICB�SE� <br /> PWM�INGCONiRACTOR IAAILADDPE55 GITV 21P PNONE Si�l[LIGiNSE/ <br /> CCMTR�PPICEOF W�K p6 —. . <br /> 1 -� <br /> DESCRiBE WORK AND SOUARE FOOiAGE INVOLVEO CONTAGi PEFSON AND PHONE NO. <br /> I <br /> E,vc%s� Pxisti'N9 ca �or a r d �es ri�Nc✓rrs�v 7S'1- azz�--- . <br /> t' i HEREBY CERTIFY THAT I HAVE READ AND EXAIdINED THIS <br /> oroseo �se oF ow�on+c APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> Ga�-a �/�', PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPF O` <br /> III LEGALOESLRIPTIONOFP�io�eaiv�SNowr+eetowoan77ncNnvocoaiEsi WORK WILL BE COMPLETED WITH INHETHER SPEGIFlED HEFEIN OFa <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GN[ <br /> LO'�� -- P.:OCK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STf�7E OR LOCAL LAW REGULATING CONSTRUCTION OR i HF <br /> PERFORAIANCE OF GONSTRUCTION.THAT I AM AUTHOR12ED BV TH[ <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR VJHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STME <br /> vnace�inx i o.�M 9, _ ������,^ �I^^�— CONTflACTORS LAW 18.27 RCW AND 29G20G WAC. <br /> U C/ �r ,c� <br /> COGSTRUC1tONL0ANLENDER.A0DRE5S.iELEPHONE NUMB[R ��! �/� <br /> _ X , -t��_� '_s��'���� -- ���-- . <br /> PHOJE T ADD ESS � "'� _ ����� _ <br /> } ^ iz � i. ", - - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE O ITEM FEE N0. TVPE OF EOUIPMENT FEF <br /> WATER CLOSET�TOILET) A'C—A%HIJDLG 11NITS—H.P. _ _ <br /> BATHTU6 FORCED AIR SYSTEMS—B.T.U. M E.A. ___ <br /> LAVAiORVIWASHBASIN) � UNITHEATERS—B.T.U. M _ <br /> SHOWER ' CLOTHES DRYERS __ _ <br /> KITCH[N SINK 8 DISP VENTILATIOfJ FAN _� _ <br /> DISHWASHER � RANGEHOOD _ <br /> LAUNDRY 7FAY ' IYATER HEATER ' _ <br /> CLOTHES WASHER � WOOD STOVE _._ <br /> UFINAL ' ME7AL FIREPLACE(WOOD BURNING) _ _ <br /> DRINK!NG i OUNTAIN I FIREPLACE INSERT _. __ <br /> � FLOOR DRAIN HEAT PUMP _.. <br /> BACKFLOW PREVENTERS ; GAS PIPING __ <br /> � ROOF DRAINS—RAWLEADERS � EXHAUST FAN __ _ <br /> SINK(SERVICE—BAfi.ETC.) I --— <br /> SUB TOTAL $ SUB TOTAL 5 <br /> PERMIT $ PERMIT S �__ <br /> TOTALFEE $ TOTALFEE S � <br /> FOR OFFICE USE ONLY: - - �j0 �e-C�ti�f���� <br /> =PONiSLi�FCN HE�RSEipACK SiDESET[iACH PL�NG�aEGKNUM�[R ��EE �[C[IPiIlO <br /> /- J7 � <br /> ur-i_wr+E ioTnaen vncnt+isiie FEES VALUATION FEE <br /> i YES __ N� pU!LDING __ 7��Z Pl �/ .�I�__- - <br /> 1���2;GONST NO.OFSTONIES o¢urvucr uo rn Venw�i:u�i��s <br /> �w�°° PLUM�ING <br /> _ _�- -1 —'__ ._ <br /> ;Ct OFBLDG. FIqESPFINNLERSREO'U BASEMENT MECHANICP.L <br /> � o "� YES f�0 /� ��-- <br /> -��{�� ADDITIONAL PLAN CHECK -- I � �� <br /> O'.,CUPANCYIOAD FIREALARMRW'D HEIGHTLIMITATION �-+ ��.�—"--,� <br /> i <br /> „( q \J✓� OTHEF i <br /> ASON — ��� <br /> STATE BUILDING SIIHCHARGC � <br /> ��u�n��:rv r�nr+s nr noveonv CITY OF EVERETT PU6LIC WORKS `J , <br /> ��c�" LOCAL SALES _ <br /> onre 3/j�/9y TAX CO�E IS 3105 rorn� �3 -_ <br />