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t7 y <br />h <br />W in � <br />m�x <br />ayxy <br />K' y'.0 <br />�M� <br />y fA N�+ <br />[�1 O � <br />H <br />��g <br />QV � <br />t� y � <br />r+ H <br />gN <br />(J c!A <br />Q � <br />HOy <br />�� � <br />� E I <br />! i'i <br />APPLICA3iGn1 ��R CiDNSTRUCT JN PERNAIT <br />the Evergiae� <br />CITV OF <br />everett <br />SUILDING DEPARTMENT T(,` BE COMPLETED IN INK--PLEASE PRINT <br />25 810 <br />EMOLII'IGN ' COMBINATION BUILDING MECHANICAL <br />OWNER MAIL ADDRESS CITY Ili' PHONE <br />;v' �� L E,�yirT_G So� c'�E� S��fy G`w.� <br />TENRNT MAILAOONES GITY 21P PHONE <br />Aft�HITECTORDE5IGNER M�ILFD�RE55 CIiY ZIP PPONE <br />G- ERAI CONTRACTOR MAit RUDflE55 • CITV ZIP PNONE <br />S firtic.r�Hr .��c /s-�'zD .Sa��� <br />u ruetiiem c�in�OR MAILADpRE55 GtY A� ZIP �� M;N� <br />PLUMOiNGCONTRAGTOF lAAILAOD9ESs <br />CLASS OF WORK <br />-..'�. NEW ��._'� ADDITION '�.�� AITERATION <br />TEN4Ni IMPBOVEMENT OR INTEfl�GR REMODEL ONLY <br />CONTRRCT PRICE OF WOPF' <br />OESCRIBE WORK AND S�iUAnE F W TAGE INVOLVCD <br />LEGAL OESCRIPTION OF PROPE <br />LOT BLOCK <br />LAVATORY <br />UflINAL <br />DRINKI� <br />FLOOR <br />BACKFL <br />aooFo <br />iINK 8 <br />1ER <br />TRAY <br />FRONTSETBACN <br />J _ <br />USE20NE <br />TYPE 0� CON51. AItOWABIE <br />$REOFBLDG. <br />OCGUPANCYLORD <br />flEA50N FOfi SPfiINKLERS <br />APPIICATION ACC. OV <br />ISHOWN BELOW OR <br />OF <br />r� <br />PLUMBING <br />. <br />Z <br />everett <br />e <br />i _ SIGN <br />��,Y / ��P `�Z" ���oy _ i <br />REPAIR EMOLIiION �. � WOODSTOVE/FRPL INSERT '. �� BUIL�ING RELOCATION 1 <br />I CONTAG: PEfi50N AND PHONE NO. , <br />I HEREBV CERTIFY THAT I NAVE READ AND EXAMINED iHIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES M1OT PRESUME TO GIVE <br />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW FEGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRU�TION. THAT I AM AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW ANO 296200 WAC. <br />SIGNFTUPEOFGONTRRG*OROFAUiHOPIZ �AGENt �ATE <br />X o��'�j�j/�j���R/� W <br />'�'7.L�/ <br />APPUCANTS CITY BUSINE55 UCENSE NO. PNO BUSINESS NAME <br />TYPE OF E�UIPMENT <br />NC—NHNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEfiS <br />VENTILATION FAN <br />RANGCHOOD <br />W/1TER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING _ <br />REARSETBPGH SiDE5ET6ACK PIANCHECRNUMBER FEE <br />LOTPREA VAGANiSITE FEES <br />'�,-] YES C. NO BUILDING <br />7YPEOFCONSI.ACIOAI tttuveNcr noo�RS'twxcwns — <br />�"wP pLUM91NG <br />NO.OFSTORIES �RSEM1'ENT MECHANICAL <br />:,YES '.�. NO — <br />FiRE SPRNKlEPS REOD MEIGHT LIMIiATION OTHEfl <br />I . YES � . NO STATEBWLDINGSURCHARGE <br />STATE ENEHGV SURCHARGE <br />PlFNSAPPfiOVEDBV CITY OF EVERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />RECEIPT N0. <br />I <br />