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_� <br /> APPLICATI�N FOR CONSTRUC ��ON PERM�T `'�`'""" � <br /> ��<,F��,�,�r,� TO BE COMPLETED IN INK—PLEASE PRINT �� - <br /> ciivor <br /> everett I HEATINGSVSTEM Ird'GAS 'JELECTHIC 'J ! <br /> BUILDING DEPARTMENT �----- ---- ------ _-_..------.� .�. . <br /> 259-8810 <br /> ���tl DEMOLITION COMBINATION BUILDING MECHAt71CAL PLUM9ING SFGW <br /> -- ------ - - -- ----- -- — � <br /> .�WNER �" MCIL�IIf t.d � CI(i�V /IP /'� PNONE <br /> �. �_' KlN(ZE�c° �'�����-���� YJ/�l�li�l�'W �a CL' �1r1� 3�70��/U <br /> a (/J itNANi MNIPDORESS QTY ZIP PHONE <br /> ��x — <br /> 'y H iRCH1iECiOROFSGNFR � M�1ILTDDBESS G!Y ]IL PHONE <br /> K� C� <br /> I��� 6ENERAI WNTRRCTOR MFILPD�RESS CIiV LIP NHONE LICENSEa <br /> w� G � Pia��2� ��I' _Tn�e �47a4 J`3� �� s �d �'�3 �v7�8R� �. ��s2 i�ENr.o <br /> �ZR� MECH�NICQ CONTRACTOR MAIL ADORE55 CRT ]IP PHONE LICENSE Y <br /> ^J � _ _ -- <br /> O H PLUM8INGCONTFACTOP MMLA009E55 CiTV ZIP PMONE LIGENSEY <br /> ��g -- --- - <br /> Qw n -.. <br /> C�' CLnSSOf WOPM <br /> ?�y a ✓NEW . ADDITION . � ALTERATION REPAIR DEMOLITION � WOODSTOVE/FRPL WSEfiT . . BUILDING RELOCATION <br /> � � CONTACT PERSON A PMONE NO <br /> H y � '�U C�. �'- "9' G87cJ <br /> �f(/� CONTPACTPRICEOFWORK _ _ — <br /> ��� DESCRIBE WORK�NDSOUARE FOpTAGE INVOIvED <br /> ��� 1�3�� .� -- <br /> vaoPose useoFew�owc � I HEREBV CERTIFV 7HAT I HAVE READ AND EXAMWED THIS <br /> y yO� g APPLICATIC.AND KNOW THE SAME TO BE TRUE AND CORPECT.ALL <br /> �ecaoEscAivnor+oFvaoaearv�sMCwNeE�owoanrrncHFouacoaie5) P(70bISIONSOFLAWSANDJRDIN.4NCESGOVERNINGTHISTV?EOF <br /> WORK WILL BE COMPLETED WITH WHETHFR SPECIFIED HEFEIN Oq <br /> �pr L _ s�ocK oF _ NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PR041SICNS OF ANY <br /> OTHER STATE OR LOCAL iAW REGULATING CONSTRUCTION OR THE <br /> -- PEFlFORMANCE OP CONSTRUCT:ON.THAT I AM AUTHORI2ED PY THE <br /> OWNER OF THIS PROF�HTV TO PERFORM THE WOFK FOR WHICH <br /> _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 fiCW AND 296200 WAC. <br /> SIGNTTURE OF WYTRACTOR OR AUTHORRED AGENT OATE <br /> �8/�i G R/LFST _ X <br /> 1`� l 80 <br /> PRPIECTADDBE55 -- <br /> � �0. � /,� AP IChNTSCITVBU51NE55UCENSENO.HNDBUSMESSNAME <br /> V <br /> :-� PWMBING MECMANICAL . <br /> NO. TVPE OF FI%7URE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> ����1� WATER CLOSET(TOILET) _ - A/C-A/HNDLG UNITS-H.P. <br /> �. BATHTUB O ; FORCED AIR SYSTEMS-B.TU. M E.A. _ <br /> i � LAVATORV(WASH BASIN) �'p � _ UNIT HEATERS-B T.U. M <br /> . �r SHOWER p ' CLOTHES DRVERS <br /> �I KITCHEN SINK&DISP �'I VENTILATION FAN <br /> � , DISHWASHER S^' RANGEHOOD _ <br /> � LAUNDRVTRAV WATER HEATER <br /> I —�1 CLOTHES WASHER � WOOD STOVE - <br /> L_ URINAL METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP _ <br /> BP.CKFLOW PREVENTERS � GAS PIPING _. <br /> .� =1 ' ROOFDRAWS-FAWLEADERS E%HAUSTFAN _ <br /> � <br /> ' SINK(SERVICE-BAR,E7C.) — <br /> ,,�-y,cc. , 2au.f'F - <br /> I ='"' � <br /> i SUB TOTAL $ p ; - SUB TOTAL $ ��. ; - <br /> �_ - — PERMIT $ - __ _'_ PERMIT $ _ <br /> 1 � TOTAL FEE $ !/ ' TOTAL PEE $ G+ ' <br /> i FOR OFFICE USE ONLY: �s`�G %° <br /> FRONTSETBACK iiEAFSETBACK SI�ESETBNCH PII�NCHEC NIIMBEN FFF AEGEIPtNO <br /> �� 2C � �r � �� I.� I L/��'.3� <br /> � usezoH�--� �o*naEn ,{ vncnrvrsirE FEES VALUATION FEE <br /> �-� �DOD j' y�s sui�owc 396 (<a6 �yac <br /> PIFEOFGONiS ALLOWABLf iVPfOFCONSi PCiUAI occu�nNCv xo OVVx[�uxcuxn5 <br /> �'fl��''� PLUMBING �p i o 0 <br /> - -J -3 <br /> SIZE�OFvB4$F r NOAF STORiES BASEMENi MFCHANICAL (p(J � n G <br /> ��' S � 2 �4� ADDITIONALPLANCHECK 3}—�� i� <br /> OCCUPFNfVLOAD FlRESGRNKLFFSREG�LI� HEIGHT�IMIiATION ___ <br /> / <br /> � NO OiHER _ "___. <br /> REPSON FpR SPRINKLERS � <br /> STATE BUILDING SURCHARGE !� � 5 l� <br /> iNTqKE PV � PLANSNPPROVEDBV CITY OF EVERETT PUBLIC WORKS ��'� �� n�,�. <br /> %(�� �oca�sn�es <br /> `� ���AX COOE IS 3105 roTn� . � � � <' F.�: , <br />