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k I / <br /> APPLIGATI6N FOFi CQNSTRIOGTi��I P�RMIT �`"`P" <br /> m�•e�wg�ean TO BE COMPLETED IN INK—PI.EASE PR(NT � <br /> �YOF <br /> everett HEATING SYSTEM: iJGAS Xj ELECTRIC J ___—� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBiNATION BUILDING MECHANIJAL PLUMBING SIGN �, <br /> OVR:[R MAILAD�RESS CIiV ZIP P��OtlE <br /> ����,�a{3.Fs / _a2� 325,��hi ia. �V���7' Ng �jP�2o3 �ti-n��os <br /> TENAtlT IAAILAOOfl[55 CITY ZIP PHONE <br /> ARCMIiECTOROE$IGNEfl IAAILAO�R[55 CITT ZIP PHONE <br /> S.iS[.(/�C � �� � (Y/�eix OL�?��^'"W/ YYi�' /���' �'rJ'S� D.:NJ <br /> H GENER�COtITRACTOR MAiLlOOFE55 Cilv ZiP PMONE LiCENSEe . <br /> ��� — <br /> a y 1�.[CNANICAL WNTRALTOR IAR�LAODRESS C�TY 21? PHONE IICENSE n <br /> ��H <br /> aH� PLUAI�iNGCONiRACTOR M�iLA�OPE55 GTY ZIP PHONE LICENSE• <br /> � Clh55OP WOAN <br /> x <br /> � � �:'1ti � NEW X ADDITION � ALTEFATION REPAIR � DEMOLITION . . WOODSTOVE!FRPL INSER? ._. BUILDING RELOCATION <br /> � H� �!DLI•� �7I4 n co�v*ac*aeasoN ar�o a�ior:e r�o <br /> y y r c �fk��/ ��9'f38 y7 <br /> CONiHACiPPIC[GG\'IOAK ( � •'� <br /> .`�+ z�i DFSCRi�E WORn AND SOUARE f00iAGE INVOLVED <br /> [iJ 0��S <br /> y d �� �n r�- ,4 nrr/oN <br /> H <br /> [y aaovoseouse Fnuaoir+c I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � [�iJ p � y�� � y APPLILATION AND KNOW THE SAME TO BE TRUE AND COflRECT.ALL <br /> �" n �ES��C� �!� PROVISIONS CF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGAL�ESLRI?iION OF CRUP[qtV;SHOIVI:OELO'N OR ATTACN(OUR GOPIE51 <br /> z H� WORK WILL BE COMPLETED W�TH WHETHER SPECIFIED HEREIN OH <br /> y y z �or oi�K _ oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUIdE TO GIVE <br /> t� AUTHORITY TO VIOLATE OR CANC2L THE PROVISIOMS OF ANY <br /> �y y y -�r/C l/ / 1 OTHER STATE OR LOCAL LAW REGULATING CONST(7UCTION OR THE <br /> p H —�r�L S � � PERFOFMANCF.OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER Of THIS PROPERTV TO PERFORM THE WORK �OR WHICH <br /> � �'r _�� OL�^ T�^C� ^ � �� � qppLICATION IS MADE AND I COMPLY WITH THE STATE <br /> [i'1 CONTRACTORS LAW iB27 RCV/AND 2962G0 WAC. <br /> yH�N SiGNAiUH[OFCONTRACfOROR�UTMORREDAGENT �ATE � <br /> .. . . .. — � .� �� '/_c—�� <br /> VRQIECTA�ORL55 _ � — <br /> �2� /��O�A Y'�--�� � O A�'PLICnfItSCITV9051NE55l:EflSEI: ANDDUSINESSNAIAE <br /> fT <br /> PLUTABING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> i� WATER CLOSET(TOILET) A�C--NHNOLG UNITS—H.P � � <br /> �I BATHTUB FURCED A'R SYSTEMS—B.T.U. M E.A. i_ <br /> LAVATORY(WASH BASIN) G�� UNIT HEATERS—B.T.U. M _ <br /> � SHOWER C ' _ Ct OTHES DRYERS <br /> �� HITCHEN SINK 8 DISP VENTILATION FAN <br /> �! —� _ <br /> DISHWASHER RANGE HOOD <br /> Ll�UNOHY TRAV WATER HEATER �_ <br /> CLOTHES WASHER WOOD STOVE <br /> �� URINAL _ IdETAL PIFEPLACE&CHIMNEV <br /> DRINKING FOUNTAM FIREPLACE INSERT <br /> FLOOR CRAIN HEAT PUMP <br /> BACKPLOW PREVENTERS GAS PIPING <br /> �^'� ROOF ORAINS—RAINLEADE�S EXHAUST FAN <br /> � SINK(SERVICE—BAR.ETC.�, <br /> �s p <br /> r9�,� _ <br /> '` ""' SUB TOTAL 5 SUB TOTAL 5 ' <br /> v PERMIT 5 PERMIT 5 'r' <br /> TOTALFEE 5 TOTAIFEE 5 . S 'C <br /> � F05 OFFICE USE ONLY: , <br /> InONTSEiBACR REARSEIpACN� Slp[SETOACN� PIANC��ECHNUMpER FC[ c� �ECEIPLNO. <br /> �� � �r � �3 � f � <br /> use.z)o')��[ �f iornr�en V4CFNi51iE FEES IALUATION FCc <br /> f� � ` BUILDING 7�J! /��(�i�!�� <br /> rvCLOf[OIRSAIlGWABIE iVP[OFLOIISIFGIOFL xm��aa nunroM�oxcma�s ��"� --J'�-'�—�-"��r <br /> �a�°� PWMBMG �rj�Q� <br /> � '/ -� _ � <br /> SiLE OF OLDG. NO.OF STORIF.S �/SEMENi MECHNNICAL / '� <br /> �39 �c/v --- — <br /> OGGIIPANCYLOAD fIqESPRNHLERSNEOV HEIGHiLIfAITATIpN �1�nITIONALPLl1NCHcCK <br /> ! <br /> �J O7HER <br /> P[ASON FOR SPR�NKI.ERi --� <br /> STATE BUILDING SURCHARGE L,'I f'� <br /> IfriAKEpY P�nr,snPr��oveoov � CITYOFEVERETT PU�LICYlORKS <br /> LOCALSALES � v ` <br /> ' TAX CODE IS 31U5 TOTAL �' <br />