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APPLICATIO� FOR CONSTRUC7''"�1N PERMIT <br /> everett ' <br />�� M,EHro,,,,, TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> everett HEATING SYSTEM: O GAS �ELECTRIC q <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ OEMOLITION ❑ COMBINATION Xx BUILDING i=i MECHANICAL ❑PLUMBING ' ❑ 'SIGN <br /> OMMER WlA0DRE5S C1TV ZIP PMX�E <br /> The Boeina Comp�. P 0 8ox 3707, MS nH-24 SPAYt�p� qA19d_7�0� ?42=Ufl71 <br /> TEN/WT AURADDIIESS CITY 21P PNONE <br /> Owner <br /> AIICNITECidlOEeqNEX /M0./�DDRE58 CITY 21P PIqNE � <br /> CDA, 4^c30 - 198th St. , SW, Lynnwood, 98036 [72-2300 <br /> OENERAICONTRAGTCl11 M�t�DORE88 CIT' ~ 21P MfONE LILENSE� <br /> MECMANICALCONTMLTOR AU0.AODREBS �:itY 21P VHONE LILENSEI <br /> PLINAlINOCONTMCION IMLLADDRE53 GTY IIP P1qNE LICENSE� <br /> C1�56 0f Y/ORN <br /> J(JQ NEW ❑ ADDITION ❑ ALTERATION CJ REPAIFl ❑ DEMOUTION ❑ WOODSTOVFJFRPL INSERT ❑ BUILDING RELOCATION <br /> Cp/TACT PERSON AND PIIONE Iq. <br /> �o„r,u�,Pn�o�wo�Engr Est � 13i3oo .__ Leonard Astemborski 2 -35 3� <br /> DE6CRIlE M/ORK/J!U BOU�RE FOOTAOE MVOLVED <br /> hmK'4 a�ti Crew shelters 73c.p�,, ��—15:� <br /> rnoroseouseoreuaorta 1 HEflEBV CERTIF'! THAT I HAVE READ AND E%AI�IINED THIS <br /> Test Equipment for Aircraft engine work APPLICATIONANDKNOWTHESAMETOBETRUEANDCORRECT.ALL <br /> LEOAL DEBCNIPTqN OF PROPERTY�5110WN BELOW Ofl�iTACM FWR COPIES) PROVISIONS OF LAW^u ANO ORDINANCES OOVERNINO THIS TVPE UF <br /> WORK WILL AE COMPLETEO WITH VIHETHER SPECIFIED HEREIN OR <br /> �oi_ e�ocrz oF NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TQ 61VE <br /> AUTHORITV TO VIOLATE OR CANCEL 7HE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW RE6UUTINO CONSTR�ICTION OR THE <br /> PERFORA'dNCE OF CONSiHUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IB MADE AND I COMPLY W!TH THE STATE <br /> CONTRACTORS LAW 78.27 flCW AND 298200 WAC. <br /> 6�6N�TUPEOiCONTRACTq10RAUfiqRIiEOMCNi D�TE <br /> PRQIEGTMDNESS � A�✓�'� �i��✓(�'�'� IL//�U <br /> 3003 W. C85100 Rd. . EV2Pett ���µTBCITYBU51NE6SLICENSENOANOBUSMESSN�ME <br /> PLUMlINO MECMANICAL <br /> N0. TYPE OF FlxTURE 9R ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � AICrAMNDLO UNITS-H.P. r <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. � � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M ; <br /> SHOWEH � CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP ; VENTIlAT10N fAN <br /> DISHWASHER RAN6E HOOD <br /> UUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL _ ' METAL FIREPUCE 6 CHIMNEV y <br /> DRINKINO FOUNTAIN � fIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE-BAR,ETC.) ' � <br /> � <br /> � , <br /> ' T <br /> 1 <br /> 1 I <br /> 1 � <br /> _ SUB TOTAL S ; SUB TOTAL S �_ <br /> PERMIT S PERMIT S � <br /> TOTAL FEE f TOTAL FEE S ' <br /> FOR OFYICE USE ONLY: �•, -�� - � <br /> FRONT 6ETB�CN REAR 6ETBACM 610E SETB�CN PIAN IrE-L�It_NU�MBER FEE REGEIPT NO <br /> USEZONE IOT�FE� v�csN*sre pEE$ VALUATION FEE <br /> 0UIi01N0 �j �:�� � — i � <br /> TYPFOfcONiS�IIOWAlIF IYPFptOMSTACIWL o[cunMcr ��doW[uiNti'.nts � <br /> �� PLUMBINQ <br /> � <br /> � <br /> 6REOFBL00 hO.0I5TORIES BASEMENt MECHANICAL � <br /> p _ � <br /> OCCUP�NGY 1011U FlRE 6PRNKLEPS REO'0 NP�NT LIMITATION 1 ADUITIONAL PUN CHECK � <br /> � <br /> _ O7NER � <br /> PEASONfpqSPqINNlERS — � — <br /> STA7E BUILDING SURCNANGE ��a <br /> INTANEBY PIANS�PPPWEOBY CITY OF EVERETT PUBIIC WORKS � <br /> LOCAL SRLES - �— <br /> TAX COOE IS 3105 TOTAI /S"7 � S� <br />� <br />