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APPLICATIt� FOR CONSTRUCT�:�JN PERMIT �Vefe« <br /> me e��e�prxo TO BE COIIAPLETED IN INK—PLEASE PRINT � <br /> CITV OF <br /> eve rett HEATING SYSTEM: ❑GAS ❑ELECTflIC U_ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ,�C DEMOLITION j�COMBIFJATION k' BUIU:!NG MECHANICAI. __ PLUMBING 1 SIGN <br /> OWNEF MAILADDRE55 �IT' + ZIP Pr10NE <br /> i J�iPr �S�oTGflL .6'L1/.�o,rSZ�c7 � _<.t',� ��f.'_C �S% '��s-1� <br /> __�_..,: <br /> TENFNT MAII ADDRES: CIT'/ ZIP PH.)I15 <br /> ^'�i7'lf� � :I I i I ( �� <br /> qRLH1TEGT OR OESIGNER MAIL ADDRE55 i QTV ZIP PHC��E <br />' ��i<%=i�/1-G�/ /�(v 02 /-�w.f/ �'YO,� .C=vt��E 7'% �i'�ZO/ ?.t z/ 3/ �o/ <br /> i GENERRL GONiRACiOR MAIL ADDR[55 CrtV ZIP PMpbE LICENSE� <br /> /�/'T �S.�oT�._ ��f3oirSLro> l���e1� avi� 9�zG�G �!%-5!�ry <br /> MECHANICAL CONTPALTOR MAIL AODRE55 GTY ZIP PNONE LICENSE R <br />( <br /> � PLUMBMG CONTRACTOR M�IL A�UflE55 GITV ZIP PHONE LICENSE� <br /> " CLASSOPWORK <br /> � � � �NEW . � ADDITION -.�. ALTERATION ._1 REPAIR .-: DEMOLITION . : WOODSTOVEiFRPL INSERT !� BUILDING RELOCATION <br /> ' �� CONTACTPEPSONANUPMONENO. ///� <br /> U�YTRACT PRILE OF WOF4 � O O�O OD � �V C IL- �- E.ati /��/ �.p'J'��- <br /> � �ESGRIBEWORKAN�SOUAREFOOTFGEINVOLVED -T� � <br /> . ��'c c r' S S�72 r ���7� �•`��9' .'� (v � <br /> . . PPOPOSEDUSEOFBWI�ING �� p I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> i � � �� �y `�� �7T-i� � ,�C p��/ A?PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> i LEGA��ESCPI IONOFPROPERTY�SHOWNDEIOWORATTACHFOURCOPIES� PAOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF I <br /> �J �� � ./ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEAEIN OP <br /> I �� �or3�{ /�L e�ocK lp�z oF r��� C��c.E��r�' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV_ '� <br />' . � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />� . OTHER STATE OR LOCAL LAW REGl4ATING CONSTRUCTION OR THE <br />� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TH[ <br />, S'G�i� �G�_ �� . ` ���y �����L OWNER OF THIS PROPERTY TO PERPORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPI.Y WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.20J WAC. <br /> r SIGNRNREOFCONTRACTORORAIITNORIZSDAGENT �ATE <br /> I PROJECT��D L- �/G� X�� �iQ.7 ��/ `--�[i/'LC%(.��t� ID/"/� <br /> i �APL G/NTS CITV BUSME55 LICENSE NO.AND BUSMESS NAME <br /> IPLUMBING MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. <br />� BATHTUB - ; FORCED AIR SYSTEMS—B.T.U. M E.A. � ' <br />` LAVATORY(WASH BASINI � UNIT HEATERS—B.T.U. M <br /> SHGWER � CLOTHESORVERS / � <br /> i <br /> KITCHEK SINK 8 DISP ; VENTILATION FAN / ' <br /> DISHWASHER RANGE HOOD �T <br /> I LAUNDRYTRAY ; WATERHEATER <br /> CLOTHES WASHER � WQODSTOVE <br /> URINAL � METAL FIREPLACE 8 CHIMNEV,'� � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAM / � � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> I ROOF DRAINS—RAINLEADEAS � EXHAUST FAN I <br />� SINK�SERVICE—BAR,ETC.) ; <br /> � <br /> � , <br />� � <br />` � � <br /> / � <br /> � <br /> _y; SUBTOTAL $ ; SUB'OTAL 5 ; <br />� PERMIT $ � PERINIT $ I <br />' TGTAL FEE $ ' TO iAL FEE S � <br />! FOR OFFICE USE ONLY: .,5��..��f.— /�J�f"1.�'� <br />' FPONTSETBACK BEARSETBACK SIOE�S qACK PLANCHEGNYUMBER FEE -,� RECEIPTNO. <br /> %� �V 7 yD � io �irs.lna� 57�v.3 <br />� usezoHe LOTAPEA vacnr�rsite FEES VALUATION FEE <br /> ' BUILDING J�'�� '� ' <br />� iYPEOF ONiS.ALIOWABIE TiPEO�CONSiALTUAI aeueeN[r Nao� ` � <br /> VMu Mc uMrtS <br />, � T cAour - ' PLUMBING �6J����d' <br /> .L <br />� ^2EOFBLW NOAPSTORIES BASE ENT MECHANICAL � <br /> IA-,� 5 '��l ; <br /> OCCUPANLYLOAO FIRESPRNNLERSREO'D NEIGHTLIMITATION ADDITIONALPLhNCHECK ���� � J <br />. �� " �� OTHER � <br /> PEAS/JN FOF SPRINRlENS <br /> �X�� STATE DUILDING SURCHARGE , , ��.�,''_. <br /> �NrnKe ar PLA s P v �.ev CITY OF EVERETT PUBLIC WORKS �>i/y� ; <br /> � LOCAL SALES <br /> �IM ZJ ZTAX CODE IS 3105 TOTAL � �4. � `�_: �� <br /> � <br />�� -- <br />