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� � b <br />b � <br />���p <br />ro�ro <br />N N <br />� � � <br />'A fi SSS <br />Mc , � <br />t� y <br />M <br />SyM <br />��JN <br />00 � <br />p N <br />1 �r <br />-. � <br />APPLICATIO�'�i FOR CONSTRUCT�ON pERMIT ���� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I I-IEATING SYSTEM: � GAS IJ ELECTRIC I� _ _� <br />6U LDING DEPARTMENI — - <br />25�-6610 <br />DEMOLITION � i COMBINATION BUILDING ,I i MECHANICAL I I PLUMBING I I SIGN <br />owt+en iani�noun[ss cnv nr ruor�[ <br />����r rlu.s,i✓4 fiui��UP�r_r __!�p� Po�r.a2 ST ��'�i?�i �'�wi a��' �zzZ <br />i�ur,Ni unanooncss cnv rm ruoNe <br />nnc�mrcionoes�,ct+r:n ranannoness citv tm rnorm <br />�D,%eerlA,✓ �,�,�.�Krs i�� ;if-w;rr �'�� �v�ee�� l,�a y'..p�o� �f 3r�/ <br />cc�:enn�coranncion rananooness cnv zir PIION[ S��i[LIC[NSE� <br />_ /r� �,f�. P�osr .._ l-�l%'.� <br />racc�mrnGntcoN�nncion nmanour�ss a�v zir ri+oHe SLAIELIGENSEI <br />PIUI.101'1GCONiMG1011 IA�IL�UO�E55 . CIIY 21P 19iONf- S1�tELIC[NSG� <br />C145S OF WOBN <br />I I NEW I I AODITION I I ALTERATION � REPMR I I DEMOLITION I I WOODSTOVE/FRPL INSERT 1 I BUILDING RELOCATION <br />CON--t�A^Ci PE�SON A1 PIION[ NO. <br />CONiRAGT PRICE Of VJOfiH ^F �� �%��0� OO(� � O �S� C� �� - �/� / <br />oescnioe vronK nruo saunn� voornce urvo�vio f <br />i. A_ .�_.. ../i in/.�t — � O.n� i9�.�n � <br />PIlOPO5E0 USE OF �UiLOING <br />Low in/Co��er /r��s;,✓y <br />LEG�I UESCR�FT�ON OF PPOFEfi7Y �SHOWN OELO� <br />l0i __ BLOLN OF <br />PRQIECi AOOnE55 <br />1�i—i3'/S'-/7 � <br />PLUMBING <br />N0. TYPE OF FI%TURE OR <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEfi <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONTSETBRCK � PE4nS[11 <br />� �I <br />ucc muf- LOT nREn <br />i I HEREOY CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE S�ME TO BE TRUE AND CORRECT. ALL <br />vouncoriesi PROVISIONS OF L�WS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HFREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER ST�TE OR LOGAL LAW REGULATING CONSTRUCT�ON OR THE <br />-- PERfOf1MnNCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED bY THE <br />OWNER OF THIS PROPEFiTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON A ORS LAW .27 RCW AND 296200 WAC. <br />�t-�.,rUs _ x /•1�x.A �L..vL�AC'/ /- � • Fy <br />s�c�inm�¢ oeie <br />tS% ci�rnusixEssiKu+sEHo <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />IYPFOFCOIIISAILOWABt[ iYPEOfCOt14.�r�VAI <br />UO C�1�/U ' l��' �l�f'� <br />52E OF OLDG. NO.OF S10Ri[5 <br />,Y� � (oE= I <br />TYPE OF EQUIPMENT FEE <br />AiC—NIiNDLG UNITS—fi.P. _ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION �4N <br />R�NGEHOOD <br />WATEF HEATER <br />WOOD STOVE <br />METAL FI9EPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />G�S PIPING <br />SIDES[RinCn �nn���.. �,.�.,.,.... <br />� .� ' [ : <br />vncnr+r sn i FEES <br />�UILDING <br />ucmrux. un a irviuurKunns <br />�y"�"f� PLUM�ING <br />�! <br />B.ISEMCNt MLCI�IANIC�L <br />Nv <br />ADUITIONAL PLAN CHECK <br />1NCY�OAD FIRESIPP,�NNlEfi5RG0'U IIGGIRUI.III�t�ON <br />� /�D �_ SPRINKLER <br />J fOR SPNNKI.EfiS <br />STATE OWLDING SURCFIARGE <br />oY P�nNs nrrnoveo or CITY OF EVERETT PUDLIC WORKS <br />LOCALSALES <br />.-, L,.,�,_ ,/IA TAX COOE IS 3105 TOTAL <br />PERMIT <br />TOTALF <br />NO. <br />� J <br />