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APPLICATIOPI FOR CONSTi;tJCT10I� PEFRMIT ��<<`'" <br /> rn��e�r�gree�� TO BE COMPLETED IN IMK—PLEASE PRINT � <br /> citv or <br /> everett HEATING SYSTEM: ❑GAS J ELECTRIC J _ � <br /> BI.�ILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMSING SIGN <br /> O�Y:�ER MAiLR��Rc55 GTV 21P PHONE <br /> —� 5�1 C �I-�—P��S y��o �,h�.� ��r �(+��e S�f�6.r�� C.a � s'�5 ) �67�`t°3 S� <br /> i�.��pry1 lAAllA00RE55 CITV ZIP PMONE <br /> � <br /> ;.R:.Nii;';TOROESIGNER h1�ILADOflE55 GITV ZIP PHONE <br /> fx3�y 3[t+E�ALCONTRACTOR MAILADORE55 CITY ZIP PHONE LICENSE• , <br /> lTJ[� n U., .�c/� <br /> ��� I.'ECNANICALCONTRAGTOR lAAILAODRESS G�T�' ZIP PHONE UCENSEs <br /> Cy' H <br /> �--ai �� PLUTA�INGCONTRACTOR 1.IAiLA0�flE55 CITv ZIP PHONE LiLENSEa <br /> H 9� <br /> y :L H <br /> F� y� CLASS OF WOFK <br /> O x O NEW ADDITION . - ALTERATION /�REPAIR DFMOLITION � WOODSTOVE/FRPL INSERT � : BUILDING RELOCATION <br /> �sJ H�TJ CONTACT PERSON AND PNONE NO. <br /> (n H <br /> �-7 z r" ccea.rcr aaice oF woaK`� '�("i�Ci — <br /> '��j y� or,s��wo_aK ar�o�soJu�aaE Footac�rrvpl.vEp �(/ �cc k, , Rp fK� <br /> I �. � i� c<fb, �3�.Lc, F7 �.c_ <br /> C H ��— � " <br /> �y �O reoaoseouseoF�eme �,�� ` Te�� I HEREBY CERTIFV TH'T I HAVE READ AND EXAMINED THIS <br /> �� APPLICATION AND KNOW �HE SAME TO BE TRUE AND CORRECT.ALL <br /> �j]V �] <br /> �ecni oescaianoNo�anorenrv�sr+owr+ne�owoannacNFouacoaiesi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � y z ior e�oc� oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H y AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OfA H '� � ` L`-r'�"� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � �y PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> C, OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 3 C�1� APPLICATIUN IS MADE AND I COMPLV WITH THE STATE <br /> zy� CONTRACTORS LAW 18.27 RGW AND 296200 WAC. <br /> y O� LIr,NAiUAF.OFCONTRACiORO�AUTNORIZEDFGENT OnTE <br /> � -9-�'� //tv�. � X_ a/� <br /> PROJECTAUDP[55 �y —�" '�^�'p / <br /> APPLiC/NTS QiY DUS���ESS I�CENSE NO.AND 6USML55 NAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EdUIPMENT FEE <br /> e"°�' +o WATEfl CLOSET(TOILET� A-C--A'HNDLG UNITS—H.P. <br /> .., <br /> +�' BATHTUB FORCED AIR S`.'STEh1S—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> ,,.�, � SHOWER CLGTHES DRYERS _ I— <br /> � _ 6 KITCHEN SINK 8 DISP _ VENTILATION FAN <br /> � � DISHWASHER RANGEHOOD —T— <br /> LAUNDRV THAV WATER HEATER <br /> '� CLOTF{ES WASHER WOOD STOVE _ <br /> !�� URINAL METAL FIREPLICE&CHIMNEY <br /> DRINKING FOUNTAIN FIREPLAGE INSEFlT <br /> FLOOR DRAIN F EAT PUMP <br /> d'_���� BACKFLOW PPEVENTERS GAS PIPING <br /> � � ROOF DRAINS—RAINLEADERS E%HAl!ST FAN <br /> SINK(SEHVICE—BAR,ETC.) __ <br /> � _� � �� � <br /> ��'~' SUB TOTAL 5 _ SUB TOTAL S <br /> � PEHMIT 5 PERMIT $ <br /> TOTALFEE S TOTALFEE S <br /> - FOR OFFICE USE ONL�: <br /> FRONt5Ei0ACK ltEn(15EiflACV SIDEliFi�ACK NLANCMECHIll11.1�ER iCE REGEIPTNO. <br /> u;ezoNE �orneea vacnursne FEES VALUATION FEE <br /> oui�oinc /S'� ; �d <br /> 1VP[OFC01liS.AILOWAOIE i:PE01CON5IALIDAI ncnrexCx NOOrownur�;u:i15 <br /> �muv � PLUM9ING <br /> SIZEOF9LDG. NO.OFSTOFIES DAS[MENT MECHANICAL <br /> Z� <br /> OCCUPANGY LO�D FlFE SPRNNLERS REO'D HEIGHT LiM1iATION ADOITIONA�PLAN CNECK _ <br /> OTHER <br /> P.Eh50N FJR SPRINNLENS —T <br /> STAT[Bl11LOWG SUHCHARGE � i S� <br /> INiArcE9V �✓�APP�����R� CITY OF EVERETT Pl1BLIC WORK$ <br /> � �LOCALSALES � <br /> ThX COUE IS 31�5 rorn� j � j fd <br />