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APPLICATION FOR CONSTRUCTI�.N PERMIT �•��«''� <br /> rna e�o.p��� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> LITV OF <br /> everett HEATING SYSTEM: I]GAS y�ELECTRIC ❑ _ —1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING ECHANICAL PLUMBING SIGN <br /> OWHER M�IL��U(VESS LIIV 21P PMONE <br /> I�[s O.o.Bo�t 3�0�_ �►ds aF�� .S�a�rnF 9s� ��1.-,ao� —!o ss -�r�l <br /> 1ENANT MFII.AOORESS CIiY 21P PHpNE <br /> BnEt�l[� �D -SD F3r.OG 'i3o 3 G+45r,,�o /Ia EI(6/tET'l Qd�i� <br /> �TRCH�I�1/ECi0R,O_E•5'1fNER f MAI���REss �r� I{�� ST CIT��� 21P�SOSS PH�O���SS�� <br /> /11t. 1lf� .�N�� ��w r <br /> O�R�pN� R���LADON53q .�L�r �rCIi��OZs/ �� ��O�O LICENSE� <br /> MELN��IC�ipq �^(� �DD����!` �YVI/� �/ /Y� ZI�/�-1 ��/� �(..VSEN/, �0.7 <br /> W � <br /> PLUMBIN�iP�C�P M�IL�DDNE55 CITY 1iP PNGNE �ESLI���I�I /S� <br /> / <br /> CUSSOF K <br /> NEW ADDITION kALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br /> � �./ DDD CONT�CT VERSON AND PHONE NO <br /> `� t 767 sm <br /> CONiP�CtPRICEOFWORR T <br /> DE RIB WORe�N�SOU�HE F T�GE INVOLVE� � 'r y�7^� <br /> - E 4e t TAt�n �„� � � n aK.� <br /> � <br /> PPO CSEDUtStEO�BtU�IlU�1NG p I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> �IIIOIOYK ,�c.NtC�$ �(Q p�1. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL UESCHIPTION OF PROPERTV� HOWN BEIOW OR ATT�GN Fdlq GOPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> "'��'� WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> PEflFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATUREOFCONTMCT qORAUTHO{IIZEDA�ENT DATE � ��' <br /> PRQIECT�DDRE55 �" �./� <br /> X ' �l�sT�r r�c. <br /> „ D /�//�L ����(' AVGLN; SCITVBU INESSLILENSENO.ANDBUSINESSNAME <br /> {J �rvo a+� <br /> PLUMlIN(3 MECH ICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WPTEF CLOSET(TOILET) AIC—NHNDLG UNITS—H.P. � <br /> BA7HTU8 ; FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> UIVATORV(WASH BASIN) � UNIT HEATERS—B.LU. M ; <br /> SHOWER ' CLOTHES DiiYEflS � <br /> KITCHEN SINK 6 DISP VENTILATION FAN <br /> � DISHWASHER � RANGEH000 � <br /> UIUNORV TRAV WATER HEATEH <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEV � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEATPUMP � <br /> BACKFLOW PFEVENTERS GAS PIPING <br /> ROOF ORAINS—RA�NLEADERS EXHAUST FAN � <br /> SINK�SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � <br /> SUB TOTAL E SUB TOTAL E � ! � ' <br /> PERMIT E PERMIT E /'� � <br /> TOTAL FEE S TOTAL PEE S ' ._',�'— <br /> FOR OFFICE USE ONLY: <br /> FRdITSETBALN RE�RSETBACH SIDESEif1�CK PLMlCXECNNUM6ER FEE _ .. _ RECEIPTNO <br /> a � - <br /> USE 20NE lOi ARE� VAL�NT SITE FEES VALUATION FEE <br /> _ �� <br /> BUILOING c��t- � <br /> IYVFOfLONiSUIOWABIF lYVEOiLON51ACIUAL octu>�M/ NOpwrtluNGUNi"S -- — <br /> �"0''� PLUMBING � <br /> SREOFBL06. NOOF570RIEs B�SEMENT MECHANICAL ,�� — <br /> i <br /> OLLUPANCYIOA� FIRESPRNNlER5RE00 HEIGHiLIMIT�TION ADOITIONALPLANCHECK � <br /> OTHER � <br /> PEASON FOR SPRINKLERS � <br /> STATE BUILDING SURCHARGE i <br /> INTAKE BY PLANS APPNOVEp BV CITY OF EVEHEIT PUBLIC�VORNS i <br /> � � / LOCAL SALES <br /> l'� � ��� TAl(CODE IS 3105 �o��� j �� <br />