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S , '� { �` <br /> � ARPLICATIOi. FOR C�O� YF'�UCTE�N PEi�MIT `'`'"`'" <br /> ryr�, ,a, ,^ TO BE COMPLE ED IN IN LEASE PRINT � ? <br /> cirv oF ' `�7 CCi � � <br /> everett HEATING SYS7EM: �1 GAS ' ELECTfiIC ❑ <br /> BII1LDIt�G DEPARTMENT — <br /> 259-8810 <br /> � � I� DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br /> „�E� Mn��nnnnc�s arv ziv ��or+e <br /> �� � �-fTac� Ri�'.oil �/H/S %or Ala[ �F(' Sx,h 9ff�9'O ��.�^ � �1�3 � <br /> � y y TENA t M�IL AODRE55 CITY ZIP �'HUNE � <br /> y��y AqCNiTECTOR�[SIGNER MRRACDFESS CIiV ZiP PHONE � � .it.,� <br /> ki n � I <br /> H ;o ° i <br /> O�� O� GCNEnALCONtR�C10{' M�IIRDDRE55 f.itt ZIP PNONE LIGENSEt .� <br /> [nF-� GIF'rt (c� ������7�ar. /S// � G.C�''YrC'/�.�e�L' �.'.o `f3� G .�o � G�NCC�'lIOQO iy�.'•��,t�-_ . <br /> H .� MECIIANI�AlCON1RPCTOR MPILAODPE$$ ��G CIV{� 7 �3 ZIP PHONE UCFNSE� � L�;��!!�� � <br /> x 7 -•.'� <br /> Rl O � .�-. . q <br /> y PLUMNnIGCONiflRGiOR IA4iL�DORE55 CITY 21P PMON[ lIG[NS[� �'•y�}� � <br /> O� � g ��. <br /> `i�l� ' •'.I <br /> Q• O O.ASSOGWOPN . .. �. <br /> \ � <br /> ..�j y 'r�7 �NEW ADDITION ALTEFATION � REPAIR � DEMOUTION �. ' WOODSTOVFJFRPL INSERT BUILDING RELOCATION �- _ <br /> �a� �(�� G)Z/ car+rn vEasoNFr�orH -:�� <br /> � H y �� //(� �U 335- �C/i3 .�,�. <br /> y CONTf1nCt PB C[OF WORN � - .I <br /> g �..� 0[SCPiBEWORNAND50l1RNEF69TAGEINVOLVED <br /> d �' Ew Co -`zu v o � 3350 � '' t, <br /> � ( , ... <br /> vnoros oaseoFouaoinc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> e�Pr I G(*✓'r+0. � APPLICATIOIJ AND KNOW THE SAA1E TO�E TRUF AND CORt7ECT.ALL , i � <br /> r7 �� iecuoescnivnor+oFrnorean�sHowNeE�owoannacHrouRcawes� PROVISIONSOFLAWSANDOROINANCESGOVERNINGTHISIYPEOF �r��'�t'::`���# <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR ",?"_';�'� <br /> ior ¢�ocrc ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TC GIVE � '�+{,+;�; <br /> J � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY . .-. . . <br /> �-C /" C R�- ' OTHER STATE OR LOCAL LAW REGULATWG GONSTRUCTION OR THE � � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BV THE <br /> � , �e� ^ ' / ^ g, n OWNER OF THIS PROPERTV TO PERFORM THE VlOFri FOR WHICH <br /> U �� APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. � <br /> `` � ' S�GNRiUR[OF ONiRACTOHORAUTNORIZEOAGENt DATE <br /> / /� <br /> PPDJECinDOR[55 � � /l `� �-� �/ <br /> C `l pPVLICA It5 QTY iNPS IICENSE NO.ANO BUSM[55 NFAIE I� . �i <br /> r, G� c^,/26rcb�(.t/Cill 1�, .�.,. <br /> PIUMBING ' MECHAMICAL � � '� '-5 '_ �� �, <br /> � � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPIdENT FEE {+-'' <br /> I ��� - AiC-MHNDLGUNITS-H.P. i '. _: <br /> WP.TER CLOSET TOILET) S � <br /> � � BATHTUB /S ; FORCEDAIRSYSTEMS-B.T.U. M E.A. 4� ����j <br /> j � LAVATORY�IYASH BASIN) f � — UNIT HEATERS-B.T.U. M . Y <br /> t. <br /> 1 � — SHOWER CLOTNESDAVERS - ' �y: { � <br /> ==1 I KITCHCN SINK 8 DISP � - VENTILATION FAN <br /> � DISHWASHER� � - RANGE HOOD `� '� . <br /> � � LAUN�RY TRAV' - ' - WAT[R HEATER V 'Y <br /> ' �_ CLOTHES WASHER � - WOOD STOVE � � � ��� , ��,. <br /> � -HRINAL ' METAI FIREPLACE 8 CHIMNEV 3^-�' <br /> 'L' <br /> 1 <br /> - � . . �i.-��� i:,� <br /> y , FIREPLACE INSERT - - <br /> I DRINKMG FOUNTAIN . � .. � <br /> '� FLOOR DRAIN � r' HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> '='�' ROOF DRAINS-RAINLEADERS � _ EXHAUST FAN <br /> � SINK(SERVICE-BAR,ETC.1 <br /> . J�.r,S/- P�O �_TO . <br /> i. _\'._' �- <br /> � SUBTOTAL $ � SUBTOTAL $ J':J ; <br /> ' � PERMIT $ PERMIT S <br /> I � TOTALFEE S 7 - TOTALFEE S <br /> �� FOR OFFICE USE ONLY: 3 ✓ <br /> FRONTSEiBRCN REARSETBACK SIDESETDRCK PLPNGNECNNUMOEP fEE RECEIPTNO. <br /> Zo� Zp � 5" �'�a3 /a �.h�[9 `,�r��t� <br /> 115E20NE totnaEn VACANi51TE FEES {� VALUATION FEE <br /> _ � � BUILOING f�'� ' � <br /> 1VPEOiL01liSFlLOYIABIE i1PE01CON5CALNAI M<uo�y�� x00��RUYUYnS � <br /> anwo � p�UM�ING 7U � ou <br /> �'�(_ -/✓ - , <br /> Sizc or n�o, �- N0.oF SrORiEs ensEMeNT MECNANICAL o� <br /> � SF r .5 �U ; <br /> S GAl pODITIONALPLANCHECK �l' o � / <br /> pCCUPANCYIOAU FIflESPRNNLERSRLO'D MEiGHTLiMITAiION o 1 <br /> � , � <br /> OTHER <br /> fiEA50N fON SPRINNLEfl$ <br /> STATE BUILDING SURCHARGE � �[ <br /> MiAKEBY PUNSAVPROVEDBV CITYOFEVERETT pUOLICWOPKS ��O �OQ <br /> LOCALSALES <br /> T� �, ��. TAX CODE IS 3105 rorn� �� j /9 <br />