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�, <br /> APPLICATION FOR CONSTRUCTI.iN PERMIT �`'���'� ; <br /> rnee�-erymen TO BE COMPLETED IN INK—PLEASE PRINT � I <br /> CITV OF <br /> everett HEATINGSYSTEM: UGAS CIELECTRIC 0 � <br /> � �ra BUILDING DEPARTMEN7 <br /> y 259-8810 <br /> q� H DEMOLITION COMBINATION BUILDING MECHANICAL y. PLUMBING I SIGN I <br /> �yyy rOWNER M�rtApDRE55 CitY 2iP PHONE <br /> M � 3 ��� .� .� � � r- • � . .ii �. �:�s . �.-%/i r,- !i/-/.>'1 , ?_Y L %�// <br /> � �O iJi /- 5' /.. � �< ' > il�` l-: '`� - <br /> � n �p�qryT MAILADDRE55 CIiV J/ 21P PHONE � <br /> H � � -- f1- <br /> � �"�� n CHiTEGtOROESIGNER �(MN��D�E55 GI1Y 21P PMONE <br /> y `� ~ .;�,�� -�� 7�r-�f <br /> �' O �y�' GCNCR�ILCONTRACTOR �0.AD�PES$ CITV 21P PHONE LICENSEt <br /> H C7 <br /> MECHRNICAICONTMGTOR MARADCRESS CITV 21P PNONE LKENSE� <br /> �"I <br /> H �g R�2cw�-.v �4� �� c��o � <br /> �� � / PHONE G..•Y/ �E <br /> �,�,N y� PIUMBIN4CONiqAGTON IM0.7�ODRE44 �/�j ^ �G'1� CIIY.OJ/�� � �l �— � �-� <br /> � �C � , x ,; �, � 1<�, � s` I <br /> �y w .!- . ' rJL�d/ ��'.�i1� �„r�' „/ f! ��I - C,r.fi� / � r � C'a'�: �i/;S T� i.":'_'' <br /> N y CLa:50FWOHK �,� _ � _ <br /> �1 CO H NEW I l ADDITION Y /�LTERATION , � REPAIR �. : DEMULiTION l''� WOODSTOV6FflPL INSERT ..i BUILDING RELOCATION <br /> �J WNTa�i PERSON AN�PHONE NO <br /> C7 l7 f/� <br /> �] r CONTR�CTFRICEOFWOFK ���.:ryp �._... r�".// %�J �GJ����% <br /> �s� OESCRiBEWORHMlOSOUAREFOOTAGEINVOWED <br /> H tn , I <br /> H O [n �I).G�� ,�i� f��,1 r�/�f i�.F�r^� <br /> rRoaosen�use0teu2omc I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br /> �/.-:. �- ,'r o�-s1S,.r6�Yv'-(� � �j� �` APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGRLUESCRIPTqNOFPROPERTY�SHOWNBELOWOFAtTACMfOUR ies� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> W09K WILL BE COAVPLETED WITH WHETHER SPEGFIED HEREIN OR , <br /> ior etocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIULATE OP CANCEL THE PROVISIONS OF AN`! <br /> OTHER STAiE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFiUCT10N.THAT I AM AUTHORIZED BY THE ' <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 29620�WAC. <br /> SIGNATUREOFLONTpAGTOPJNAUTNOFIZEDAGENT �FTE <br /> ZCo�`l A C, _ <br /> . _lrnaecr��oo e� __ ., L :: : ..,� ;,< //f -sf!�/' � <br /> X / i 1y/ � / �PPLiCANiSLIiY0U51NE55LiCEH$ENO.ANOBIA,MESSN�ME I <br /> ��� 'v i.� � l ._ ti l�� " .'J. �i : : . ,.,/./i� /i/J,. f i <br /> PLUMBING MECHANICAL <br /> 1 ' NO. TYPE OF FIXTIIRE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE _ ' <br /> � WATER CLOSET(TOILET) AiCrA'HNDLG UNITS—H.P. <br /> '�1 6A7HTU8 FORCED AIR S`.'S1EMS—B.T.U. M E.A. <br /> LAVAfORV(WASH BASIN) UNIT HEATERS—B.T.LL M <br /> ' ' SHOWER CLOTHES DRVERS , <br /> � KITCHEN SINK 8 DISP VENTILATION PAN , <br /> f�' DISHWASHER i FlAiJGE HOOD <br /> LAUNDHV TRAY i WATER HEATER <br /> ' ' CLOTHESWASHER � WOODSTOVE � <br /> � AIETAL FIREPLACE 8 CHIMNEV ' <br /> URINAL � <br /> '� DRINKING FOUNTAIN i FIREPLACE 1NSERT � � <br /> �; FLOOR DRAIN HEAT PUMP � �'n��� <br /> � BACKFLOWPREVENTERS GASPIPiNG i <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> ' SINK�SERVICE—BAR,ETC.) , <br /> ' � <br /> �' � , <br /> ' SUB TOTAL $ ; SUB TOTAL S ' '� -�r�•,��;�' - <br /> PERMIT $ � PERMIT $ �A�4,� "' <br /> TOTAL FEE $ � <br /> TOTALFEE S h � ,�����,- - " <br /> i,.,_ . <br /> POR OFFICE USE ONLY: '�s' <br /> fRONTSETBFCN AEpRSETBALK SIpESETBRCN PLANCNECKNt1M�Efl �EE �ECEiPTNO. ,�;fi�� . <br /> usezove LOiAREA V�LRNTSI7E FEES VALUATION FEE <br /> OUILDING � <br /> lYPEOiCON75.AllOWhBIE iYPEOiLON9.AC10A: atW�Nv uowoMuhc�ns � <br /> cnav p�UMBING i � <br /> ;aeoFo�oc. no.oFSToaiEs B�sEMEni MECHANICAL <br /> OCCUPANGYLO�D FIFESPRNNLERSREOD NEIGMTUMITATION ADOITIONALPIANCHECK i <br /> � f: <br /> OTHER � . _ . .e_, y . ? <br /> PEASONFOPSPpINNLENS �— - - � . � <br /> STATE BUILDING SURCHARGE � � <br /> rt�ink[6Y PLANSAFPROVEDBY CITYOFEVERETT PUOLICWORKS <br /> LOCAI SALES <br /> TAX CODE IS 3105 rorai <br />