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� <br /> APPLICATIO.� FOR CONSTRUCTI.�N PERMIT ��«P« <br /> rne e�e�p�oe� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> everett HEATING SYSTEM: U GAS ❑ELECTRIC U _ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ,X BUILDING MECHANICAL PLUMBING SIGN " <br /> OWNEP 1A�IL�U�RESS GfV 21P PNONE <br /> THt BoEiN� ��. ►.o • B�x 3�e o�- � S��a'[,6, l.i� .9B�a.� ��ya - <-��� <br /> TEN�NT NML� RESS CIfV 21� PHONE <br /> SR'M E fK O Ud 6�1. <br /> ARCHITECTOROESIGNFR M�II�DDNE55 CITY 2iP VNONE <br /> �?F6 �T/r+ Go <br /> GENENALGdITR�GTOR M�ILAODRE55 GITV ZIP PNONE IICEN�E• • <br /> 59�rh�' i0s �4�.�N �rccT <br /> MECNAN�TOfl MAIIADORE55 CITY ZIP PHONE UCCNSE• I <br /> PLUMBINOCONTR�CiOR MAILADDRE55 C11Y IIP VNONE IIGENSE• <br /> .Cy$SOFW011N <br /> K NEW � �. ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVBFRPL INSERT . BUILDING RELOCATION <br /> CONL�GT PERSON ANO PHONE N �'�yy�P <br /> CONTRACTVPICEOiWOHN L�dNA-�•� 7�/�'�IOAs�'� Z�`���� <br /> DESW16EY/OBKNIDSOU�REFOOT�GE OLVED ,� <br /> ���✓o9n�n� ��M�T <br /> PROPoSEDUSCOFBWLDING 1 I HEREBV CLRTIFV THAT I HAVE READ AND EXAMINED THIS � <br /> �* � <yO y L APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> LEO�LDESCRIPTIONOFPROPERttISNOWNBELOWORATT�CNFOURLOPIES� PROVISIONSOFLAWSANOOPDINANCESGOVERN�NGTHISTVPEOP � <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE �� <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PEFiFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> SIGN�TUREOFGONTR�CTOROR�UTNOR1IED�GENT OA7E <br /> P^RQ7�IE.CTADDRESS ���Q • ��4�i^�� ��,��/ <br /> J"G� L✓ �OS/A/O D- Le6 yG �3� �P��ANTSCITVBlI51NE55lICENSENOFNDBU5ME55NM1E <br /> PLUMSIN6 MECHANICAL . <br /> N0. TVPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/�/VHNOLG UNITS—H.P. _� <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.TU. M � <br /> SHOWER CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTHAV WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUM� <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF IIRAINS—RAINLEADERS E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � � <br /> I � ' <br />� SUBTOTAL E SUBTOTAL S ' <br /> PERMIT S PERMIT S <br />� TOTALFEE $ TOTALfEE E <br /> FOR OFPICE USE ONLY: <br /> FRONiSETB�CN RE�RSETB�CN SIDESETBALN PlANG11ECKNUMBER fEE FECEIPTNO <br /> °r� a7(� Yo •�e.�r. � � <br /> USE ZONE iot eaee VACANT SITE FEES VALUATION FEE <br /> �!IG FoUN7�*I�al � <br /> TYVE Of GON75�Ll �BIE iYPE Oi CONSt AC U�l occur�xr No a oMwNr,vxns - � <br />' // _ — / _ �4R0�° PLUMBING i <br /> S12EOFBLDG NOOFSTORIES P�SEMENT ��ECHANICAL � <br /> OCGUP�NCY LO�O FIOE SPONNlERS REO'D HEIGNT 1IA11TQION ADDITIONAL PUN CHECN <br /> � <br /> OTHER <br /> REASd1 FOR SPRINNLERS — �T— <br /> STATG BUIL�ING SURCHARGE � <br /> i <br /> INTANEBY PlAlIS PROVEDBY CIiY OF EVERETT PUBLIC WORKS <br /> �� LOCAL SALES � <br /> TAl(CODE IS 3105 rorn� / <br /> J <br />