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APPLICATI� FOR CONSTRUCT�N PERMIT everett <br /> �EMrom� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> ciTr oc } <br />' eVerel� HEATINGSYSTEM: OGhS �EIECTRIC C) <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> O DEMOLITION J COMBINATION xx BUILDINQ ❑ MECHANICAL C PLUMBINCi ' ❑ 'SIGN <br /> pyyryEq G�RAODRE69 CITV 21P iHONE . <br /> The Boeina Comoanv P 0 Box '+707 MS OH T4 CP�tf�P� oai�e ��n� �a�_nn» <br /> TEN/WT MAL�DDRE56 CITV 21P VIIOME <br /> Owner - — <br /> �RCMITEGTOROEBqNER M�ILIIDORE68 GITY ZIP PHONE ' <br /> CDA, 4230 - 198th St , SW, Lvnnwood 98036 272-2300 _ <br /> OENEMLCONTMCTOA M�1/WDRE59 CITY 21P PNONE LICENSE� <br /> MECNM11C11LCONTRACTOR M�ILI1WNEbS GITY ZIP PHONE LIGENSE� <br /> p��yp�p�7p/�7pp UA4110URESS CiTY 21P PIqNE LICENSEI <br /> ��ASq Oi W�IIK <br /> XJ(I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIp ❑ DEMOUTION L7 WOODSTOVBFRPL INSEHT ❑ BUILOINO RELOCATION <br /> CON7�CT PERS.iN/JID PIIONE NO. <br /> Cp�TRl1CTPRICEOFWORNE�I r Est � / 30o Leonard Astemborski 2 6-35 3 <br /> pEg�qi9E Wpplf�qp 50U�PE FOOT�OE IHVOLVED <br /> ,Qs.i��ovr� Crew shelters 3u��, �s—�`�l <br /> rnovoseouseaevaou+o I HEREBV CERTIFV THAT I HAVE READ ANO EICAMINED THIS <br /> Test Equipment for Aircraft en9ine work APPLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> �(pkpESCq�PTqNOFpROPERTVI6NOWNBELOWORATTACNFJURCAPIEB) PROVISIONSOFLAWSANDORDINANCESQOVERNINOTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETfIEH SPECIFIED 1'.EREIN OR <br /> iot ��K a NOT. THE ORANTINO OF A PERMIT DOE'� NOT PRESUME TO OIVE <br /> AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW RE�ULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROCERTY TO PERFOfiM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH �HE STATE <br /> CONTRACTORS UW 1827 RCW AND 286200 WAC. <br /> 510NANFEOFCONTN�CTORCNI�UTHON�ZE0A0ENT ��TE <br /> X� �,,,fw�' /L//�U <br /> vro�cr/woness <br /> 3003 W. Casino Rd. , Everett �P��µTfiCITYBU81NE64ULENSENO�NOBUSINE55NM1E <br /> PLUMlINO MECNANICAL <br /> ►p, TYPE OF FDfTURE OR ITEM FEE N9. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�AMNDLO UNITS—H.P. � <br /> BATMTUB ' FORCEO AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOflV(WASH BAS�N)� � UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHES�RYERS ' <br /> KITCHEN SINK 6 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HO00 ' <br /> LAUNDRV TRAV ; WATER HEATER ' <br /> CLOTHES WASHER � WO00 STOVE � <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY ' <br /> DPINKINQ FOUNTAIN � FIREPLACE INSERT _T <br /> FLOOR ORAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPINO _ <br /> qOOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SEHVICE—BAR,ETC.) � <br /> � <br /> i <br /> � ' <br /> i <br /> � ' <br /> � ' <br /> SUBTOTAL S ' SUBTOTAI f ' <br /> � <br /> PERMIT E � PERMIT S _T <br />� TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: `i z G 3[o <br /> f110NT SETB�CK RE�R 6ETB�CK SIDE SETB�CM PUN CHECN NUMBER FEE RECEIPT NO. <br /> 1 _ <br /> � <br /> ustzone LOT�REA WC�Ni51TE F ES VALUATION FEE <br /> BUILDINO i 3c-. - /S3; ' <br /> TYPf Oi CONIS�ItOW�BIE tYPF Of CONSI ALN�I acuwcr xo d owtu�wc�Mir{ �- � <br /> GR01� � PLUMBINO � <br /> i <br /> I 6RE OF BLDO. NO Of STq11E5 B�SEMENT MECHANICAL � <br /> 7GCUPANGYIO�D fIRESPRNNIERSREO'0 HEIONTIIMITAT10N �ODITIONALPLANCNECK � <br /> i <br /> � OiHER i <br /> PE�SON FOR 6PPINRLERS � <br /> � STATE BUILDINO SURCHARGE � S D <br /> � INT�NEBV PLANSAPPPOVEDBY CITYOFEVERETT PUBLICWORKS i <br /> LOCAL SALES � <br /> TAX CODE IS 3105 ror�� 5 ; a <br />