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dm <br />Ll <br />Ma( <br />APPLICATIO?eFOR CONSTRUCTI(A-A PERMIT <br />rN, r TO BE COMPLETED IN INK —PLEASE PRINT <br />o Tf 0 <br />everett HEATING J GAS ELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />__-DEMOLITION COMBINATION J,BUILDING �,MECHANICAL PLUMBING <br />iW04R Wit A00RESS rity PHONE <br />kk.. <br />— _MAA_ ADOPE$5' city ZIP PHONE <br />;A—CHIJEC( �t)F <br />� <br />CITY <br />zip PHW, <br />NERAL ONIAACTCA <br />it, ADDRESS cffy <br />1 7r;l <br />Zp UCE W:l <br />k4Eu4Af,VCAL CONTRACIOA <br />MA9L ADDRESS <br />city <br />Tip PHONE LICENSE <br />m 01ARInG ccf4mm"i <br />MAu, ADOMESS <br />CATY <br />zip P40NE JACENSE <br />i SS OF WORK II .lc,Aj AnniTinki AlTr-RATIM <br />REPAIR DEMOLITION <br />WOODSTOVEJFRPL INSERT BUILDING REL <br />CONTACT PERSON Agm4i'.)NE ton jr <br />FOOT INVOLVED x <br />AND SQUARE 1ol <br />DESCRiat WORV <br />O ,A.� <br />w fft, f-r—A <br />ym <br />— <br />PROPOSM USE or WILNUG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMIt <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COR <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIc <br />OF PROPY1 ISHOWN [)[LOW OR ATTACH FOUR Copivsi <br />WORK WILL RE COMPLETED WITH WHETHER SPECIFIED H <br />U01 BLOCK <br />NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME <br />AUTHORITY TO VIOLATE 08 CANCEL THE PROVISION! <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK F( <br />APPLICATION IS MADE AND I COMPLY WITH TH <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC� <br />SAITIUIRIE 0 Olft ,M:-1 04ENT DATE <br />e S'sirx <br />ZT01fl <br />X <br />: <br />L icitiSf Na, AND ftUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />Fl <br />WATER CLOSET (TOILET) <br />&C—KHNI)LGLINITS—H,P, <br />BATHTUB <br />lei <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. IM <br />SHOWER <br />DRYERS <br />KITCHEN SINK & DISP <br />-CLOTHES <br />VENTILATION FAN <br />DISHWASHER <br />RANGEHOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />URINAL <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />CKFLO _jAW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />* tt <br />----------- <br />e <br />SUB TOTAL $ <br />SUB TOTAL $ <br />0 <br />PERMIT $ <br />PERMIT s <br />-- <br />TOTAL FEE $, <br />TOTAL FEE fl <br />14 <br />rnn nrl:lrr 1 lrF nNLV: <br />35 2.3$— <br />