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,. � <br />APP�.:^AT'I�Jw� 6=C,�R CONSTRUCTG�N R�RMIT everett <br />u�ee�eryreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITY OF <br />�verett HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLITION f I COMBiNATIC:PI '! BiJILDING I I MECfiANICAL ❑ PLUMBING �SIG� <br />owr�en MNV.�DIlESS cirr zir PIIONE <br />IEN�NT M�ILADORE55 CITY ZIP PHONL <br />k' 2 Cocu�aiv l"�vT�Z �9G SGr 6�e�r MRLL I�AY. �i�tl' <br />PfiCNITfC10fl�E51GNER M�ILAOORE55 GITY ZIP PHONE <br />r1DORESS <br />Gl SSOFWORK <br />� .NEW I_I ADDITION ! 1 ALTERATION <br />��� <br />CON7RACTPNCEOPWORN <br />O[SCRIDE WO�K �ND SOU�RE FOOTAGE INVOLyED_ <br />rnorosro use or sunoiNc <br />�ot <br />rnaecr nooness <br />zm <br />ZIP PIIONE <br />cirr nr <br />LICENSE N <br />� <br />LI�ENSE M <br />—.�'/i'R'/i <br />LICENSE I <br />�sa mc.v <br />LJ REPAIR ❑ �EMOLITICN i I WOODSTOVE/FRPL INSERT ❑ DUILDING RELOCATION <br />�CONTACT PFRSON �ND PyONE NO. <br />1/. _ >>/,—P.P2�' <br />� anoreen �si�owN ae�ow on nrTnai Foun cori�si <br />ALOCK _ OF _ <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />BATHTUB <br />LAVATORY <br />SHOWER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />�RINKING FOUNTAIN <br />FIOOR DRAIN <br />SINK <br />FOR OFFICE USE ONLY: <br />i'R01lTSEID�CH . I REARSEIBACK <br />r— �l.G 1 . c— <br />�' ' / � <br />IVPE OF C(711I5. AllOYUAI[ <br />512E OF OIOG. <br />OCCUPAHCVLGA� <br />nensor+ Fon srniuK�Ens <br />crra:e r.v <br />"yi.� � �' 3Y.L � <br />iYPEOFCONSi.AGIOAI <br />NO.OF STORIES <br />ev <br />$ <br />NA�wNL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OFlDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFlEIN OR <br />NOT. THF. GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANC[L THE PROVIGIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE Of CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADF AND I COMPLY WITH THE STATE <br />CONTRACI�ORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNATUREOFCONTfi�ClOfiOfl�U7HORIZEOAGENT DATE <br />" //a� �1. <br />If= QS nr <br />FEE N0. <br />SIOE SET�ACH <br />,✓v <br />Octureutr nnorPHRUIIGUxrts <br />cnour <br />BASEIAENT � <br />CITY OF EVERETT <br />LOCIIL SALES <br />TAX COOE IS 3105 <br />TYPE OF EOUIPMENT <br />FORCED AIR SYSTEMS—B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDFYERS <br />WATER FIEATER <br />WOW STOVE <br />METAL FIREPLACE & <br />FIREPLACE INSERT <br />HEAT PUMP <br />PLAN CHECK NUMDEfl <br />BUILDING <br />PLUh1DING <br />MECHANICAL <br />ADDITIONAL PLAN CHEGK <br />OTHER <br />STATE BUILDING SURCHARGE <br />auouc waRi<s <br />TOTAL <br />FEE <br />,� - <br />NAME <br />E.A. <br />SUB TOTAL $ <br />HECEIPT NO. <br />n <br />� <br />i <br />