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�e i <br /> LIPPLICATId� FOR CONSTRUCT�N PERMIT <br /> everett <br /> �E��� TO BE COMPLETED IN INK—PLEASE PRINT � ' <br /> cirv oF il <br /> everett v�qTiNG SYSTEM: l..GAS �E'LECTRIC C� --� <br /> BUILDING DEFARTMENT — --- -- <br /> 259-8810 '` <br /> ❑ DEMOLITION ❑ COMB:NATION � BUILDING ❑MECHANICAL ❑PLUMBIN(i ' ❑'SIGN ''� <br /> ; <br /> pyMQR MAILMDRE65 GffY TIP PIqNE . �..rl. <br /> The Boeina• Comoapy P 0 Box 37n7. Mc oH_24, saattta_ aAt�a_��n� �a�-na�i .� <br /> ��� IMR�DDRESS GITY 21P P/IONE <br /> Owner `;� <br /> ARCNRECTORDE6qNER MAILMDRESS CITV 21P PIIONE �� � <br /> CDA, 4230 - 19£!th St. , SW, Lynnwood, 98036 272-2300 b �;,� <br /> OENEMICONTN�C�OR WRMDRE54 CRY ZIP PHONE LICENSEI .t]' <br /> p <br /> MECNANqN.CONTF�OTOR M�0.�DURESS UTY 21P PNONE LICENSE� ' � '�:�� <br /> PLIMlINOCONTRACTOR MAIL/�WRES9 CITY 21P YMONE LICENSE/ ' . � .t��. <br /> °r:P, <br /> CIASBOF WORN :' <br /> J(J(I NEW ❑ ADDITION ❑ ALTERATION IJ REPAIR ❑ DEMOUTION ❑ WOODSTOVEIFRPL INSERT ❑ B'JILDIN6 RELOCATION , <br /> * CONTACT PERSON ANO PMONE Iq. � <br /> ca,,,ucrvn,ceoFwwncEngr Est /3�30o Leonard Astemborski 26 -3563 I <br /> pE9CR9E WONf/iND BWAPE FDOT�GE INVOLVED � <br /> �,,n�� 2c�os� Crew shel ters B�-04 �fs" -Z 3 Z I <br /> pnovoseouseoFeuwma I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> Test E U{ ment for Ai rcraft en 1 ne work APPLICATION AND KNOW THE SAME TO 9f TRUE AND COFRECT.ALL <br /> �au,peecqirrqn oc`MWEPTY�SNOYIN BELOW OR ATT/�CH FWR COPIEB� Pl:OVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TYPE OF I <br /> WJRK WILL BE COMPLETED WITH WHETHLR SPECIFIED HEREIN OR <br /> wT aocK _ � N�T. THE 6RANTINa OF A PERMIT DOES NOT PRESUME TO OIVE <br /> <.UTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REOl4ATIN0 CO�'3�FlUCTION OR THE <br />�'� -- PERFORMANCE OF CONSTRUCTION TMAT I AM AUTHORIZED GV THE <br /> OWNER OF THIS PROPEHTV TO PERPORM THE WOH�i �OR WHICH <br /> APPLICATION IS MADE AND I (�OM;'LV N'i �+ THE STAT@ <br /> CONTRACTORS LAW iB.27 RCW AND'[96.?d'WAC. <br />�� 616NATUIIEOFCANTNACTOqORAUTNq112ED110EN1' D�TE <br /> FRWECT�DONE59 � A��"�M I.���� _' IL//�U <br /> 3003 W. CeSinO Rd. , Everett ���T6CiTYBUSINEfi9LILENSEND.�NOBUSiN.JeNMAE —. <br /> PLUMlINO MECMANICAI <br /> NO. TYPE OF fll(TUf7E OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � N�NHNDLG UNITS—H.R � � <br /> BATHTUB ' FORCEO AIR SYSTEMS—B.T.U. M E.A. ; <br /> UVATORY(WASH BASIf i) � UP'�T HEATERS—B.T.U. M � <br /> SHOWER � � CLC�fIESDRYERS ! <br /> KITCHEN SINK 8 DISP ; VENTIUTIJN FAN � <br /> OISHWASNER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHEC.WASHER � WOQD STOVE � <br /> URINAL ' METAL FIREPLACE 6 4HIMfJEY ' <br /> DRINKINQ FOUNTAIN i FIREPLACE INSERT _ i <br /> FLOOR DRAIN � HFAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPIN6 ' <br /> ROOF DRAINS—RAINLEADERS � ExHAUST FAN � <br />� SINK(SERVICE--BAR,ETC.) ; � <br /> � <br /> i � <br /> � � <br /> - � � -- <br />, � ' <br /> — , � <br /> SUB TOTAL S ' SUB TOTAL S �_ <br /> PERMIT E � __ _ PERMIT S � <br /> TOTAL FEE S ' TOTAL fEE S ' <br /> FOR OFFICE USE ONLY: � �G .T� <br /> FRONTSETB�CN RE�R6ET0�CR SIDESEI9ACN �UN NEC1tNUMBER FEE RECEIPTNO. <br /> IISE 2p1E lOT�RE� V�LANT SIiE E$ VALUAI ION FEE T� <br /> euaomo 3 3�-, - /S3 � o° <br /> iYPfMtONTSAILOW�lIE ttPEO�CONSi.�tNAI aaw¢� worcowtumcunn ' i <br /> �"0� � PLUMBINd i <br /> -�T <br /> � <br /> 6RE OF BLDO. NO.OF STORIES B�SEMENT IAECI�i�NICAL � <br />�} OCCUVANGY LO�D FINE SPBNNlER9 REOD NEIONT LIMIU�ION �ODITIONAL PLAN CHECK _ i <br /> I. � <br /> OTHER � <br /> REASON FOR BPRINRI[RS � <br />" ' STATE BUILDING SURCMARGE �J_S D <br /> : i <br /> Mi�MEBY vuns�rrnoveor.• � CITYOFEVERETT PUBUCWONN$ � <br /> LOCAL SALES —''— <br /> TAI(CODE IS 3105 TOTAL �5-7 ;rJ <br />� <br />