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;-., ---- <br /> APPLI�ATION FOR �ONSTRUCT �ON PERMIT �`'���« <br /> mne�ei�iee� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> GTV OF <br /> everett HEATING SYSTEM: J GAS ❑ELECTRIC ❑ 1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> x � � �CDEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> ti1 <br /> [ � H OWNER; ��N �1.��A�RE55/ ZIP PHONE <br /> J � .ZO 5! � ��� .�E ��K�'S�ea/e.uS 33 Y 78'�f� <br /> 9 H VJ TENANT MAILAD�FE55 CITV ZIP PMONE <br /> 1 �� � TRCHRECTOROESIGNER MARRDORESS CITY ZiP PHONE <br /> H �1 <br /> I�yy H � GENE L TPACtOR �1AILA ESS CIN ,ZIP PIIONE LILENSEa <br /> � H .v2.aiUou�,v -v s�,e�-c��a�v g l I I 3 / °�/1-+�e /✓� ,q c�i�l�'[' /G 9/1lL <br /> .7. O � MECHFNiCAL CONTRACTOR I.IAIL ADDRE55 CIiY ZiP PNONE LI�ENSE a <br /> [t� ��1 <br /> Hl7 <br /> PWMBINGCONTRACTOR MAILAODRESS Gltt ZIP PHONE LIClNSE> <br /> �� g <br /> �` nC, cwssoFwonK <br /> z H 3. �_� NEW �� ADDITION . �. ALTERATION � � REPAIR xDEMOLITION ... WOODSTOVE/FRPLINSERT � BUILDINGRELOCATION <br /> � y �z <br /> H y CONTACTPER59NA[lDPHONENO <br /> � CA COtliRPCiPRiCEOFtYOFK �� „U �'1—S'�3 <br /> � � � DESCRI�E\VORKr1NO50UARE�00TAGEINVOWED <br /> L�] � <br /> ❑rrora�ouseoFem�mrvc I HEREBY CERTIFY THAT I HAVE RE.4D AND EXAMINED THIS <br /> y HO y �� NG ���—� �yy—/ ��� � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL�ESCRIeTION OF PqOPERTY�SHOWN 3ELOWOF ATf G ,�FO"UR COPIES� / PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> d �oN 2�/J"DD WaRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> •�or � 4 Z Enock �iI 3 oF NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� ���,� OTHER STATE OR LOCAL LAW REGULATWG COIvSTRUCTION OR TNE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LN .27 RCW AND 296200 WAC. <br /> SIGNATUREOFC R ORORAUTHOP12EDAGENi OATE <br /> X � <br /> PROJEGTACORE55 <br /> . f�O/ ���` g�L^ y^�tQeY'� AP BO51 IICENSENO.AN USINESSNIME <br /> lJ J.J (} �/ <br /> PLUMOING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> , ' WATER CLOSET(TOILET) A/C— HNDLG UNITS—H.P. <br /> BATHTUB FOflCED AIR S`.'STEMS—S.T.U. M E.A. ' <br /> 1�' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> —� <br /> '�' SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> 1�' - LAUKDRY TRAV WATER HEATER . <br /> 0�� � CLOTHES WASHEF WOODSTOVE . <br /> URINAL METAL FIREPLACE&CHIMhEY <br /> ' ' DRINKING FOUNTAIN i FIREPLACE INSERT <br /> � FLOOR DRAIN HEAT PUMP <br /> '�' BACKFLOW PREVENTEFiS GAS PIPING ��, <br /> � ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> O ' SINK(SERVICE—BAR,ETC.) I <br /> � <br /> ''' <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> ' PEFMIT 5 PERMIT 5 <br /> ' TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> ._. . FRONi SETBACK �EAR SETBACN SIDE SETBAGK PLAN GHECK NUAIBER FEE RECf[IPT NO. <br /> usezoNe �ornaea VACFNTSITE FEES VALUATION FEE <br /> BUIIDiNG <br /> ivPEOfGONiS.ALLOWA9lE iVPEOfLONSi.AtiOAI OCGuvARYv .9o�pwENxGuxrtS <br /> �POp° pLUMBING <br /> SITEOFBLOG. NO.OFSTORIES BASEMENT MECHANICAL <br /> OCCUPANCVIOAD FIRESPRNKLERSPEO'D H[IGHTLIMITATION ADDITIONALPLANCHECK <br /> OTHER <br /> qEASON fpq SPRINKlEflS � <br /> STATE BUILDING SURCHARGE i� <br /> iu�neenr ��nNsaPP o.9 �E�oY CITYOFEVERETT PUBUCWORKS ' <br /> .h ci:t l�•_p LOCAL SALES T— <br /> ;,Q,..� �,;� TAX CODE IS 3105 rora� <br />