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APPLICATIO�N FOR CONSTRU�T�OPi PcRMIT <br /> CITY OF EVERETT• BUILDWG piVISION � <br /> 3200 CEDAR STREET• EVERETT, WP,98201 • 259-8870 <br /> �� PEMOLITION IXI COMBINATION fl BUILDING f� MECHANICAL t 1 PLUMBING f 1 SIGN <br /> PROJECT ADDRESS <br /> 7.�( � d E T l-rJ �I��n % a S�- /SG� <br /> OW ER MAILAODRFSS CITY ZiP PIION[ <br /> �c-Tc r1c ���.�F a 3�0 � iS"J �� SE�-/ c�C// ���z I y�7-ySS� <br /> T A�T MrIILqDDRF.55 CITY / ZIP CIIONE <br /> I�E I� � ��5� � SEE /�,E°GIE�T �g �l�('�SC� <br /> anauTccr oQa oesic��en �nn i n oness cirr nv r��or�e <br /> �l/ <br /> �EN���ACtO� MAI�AC�NE55 CIIY Z�P p�tONF. $TAi[IICENSE v <br /> l/ <br /> i� /�/G(J—rl/iPf' <br /> MECHpNICALCONTRACTOR MAILADORF.55 CITY ZIp PIIONE STqTF.UGENSE� <br /> PWM91NGC0_NiRAf,TOR MAIL�O�RF.SS CIPf 21P PIIONE $TATELICENSE• <br /> CONTRACi PRICE OF WORK <br /> --- � ��� HEATING SYSTEM: I�(GAS �1 ELECTRIC f� <br /> DESCRIBE WORK AND SppnqE FOOT�GE INVOL E CONTACT PERSON AND PNONE NO <br /> /Ns i,��./�ill /TiDrU L 'C- c- c - '�3�-95�� " /� � <br /> ar-� �� r T a 6G - 9� a w <br /> �U�% / ' U ��L .1 I HER[BY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1'qOF'OSED USE OF 9UILOING ,V APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> !��S/ llCr��`A.L r'ROVISIONS OF LAWS AN�ORDIIJANCES GOVERNWG THIS TYPE OF <br /> 1` �L' Pr WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> IEGRLOESCRIPTIONOFPROPERTY�SHOWNBELOWORATipCMTWOCOPIES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or atocrc or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION 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 MADE AND I COMPLY WITH THE STATE <br /> PA LEL Tax I 0.NUMPEn CONTRAC R rLAW 1 B27 RCW AND 296.200 WAC. <br /> �3SSD �- 3��-- D� - Q� /A'/' , '/// • <br /> CONSTRUCtIONLORNI.ENOFfi.AUDRE55.T�EPNONENUMP.EP x (/`�" �✓� �jG4-�.�� �, � / <br /> 7 <br /> SIGNATI ��� DAT[ <br /> CITV BUSM[55 LICENSB N(1. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-A/HNDLG UNITS-H.P. � <br /> _ BATHiUB FORCED AIR SYSTeMS-B.T.U. M E.A. � <br /> LAVATOFlY(WASH BASIN) � H[AT PUMP � <br /> SHOWER UNIT HEATERS-B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS � <br /> DISHWASHER � VENTILATION FAN � <br /> �AUNDRYTRAY � RANGEHOOD � <br /> CLOTHES WASHER i WATER HEATER � <br /> URINAL WOOD STOVE <br /> DRINKING FOUIJTAIN METAL FIREPLACE(WOOD BUFiNING) i <br /> FLOOR ORAIN � FIREPLACE INSERT(WOOD BURNING) � <br /> B.�CKFLOW PREVENTERS GAS FIREPLACE ' <br /> SINK(SERVICE-BAR,ETC.) GAS RANGE i <br /> 6AS PIPING <br /> i EXHAUSTFAN <br /> i <br /> — i <br /> — �— <br /> SUB TOTAL $ ' SUB TOTAL $ � <br /> PERMIT S PERMIT 5 � <br /> TOTALFEE 5 TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> �RONTSFTpACN RF/OGF.70ACK 51DESETPRCK PIANCIIEC N U11FR fFP RFf.GIPiNO <br /> use2or�e �oraaEa vncnNtsir[ �/EES � VALUATION FEE <br /> r— <br /> _ iives r;u nuuniNc �{'p 2� '� `� <br /> IIEIGIIT UMITATION NO OF DWELLING S4F.Of OLU[:rtl � - �— <br /> UNIiS � PlUMI11NG — ---- /' <br /> xl ST v _ ��— <br /> OCCUPO^'Y NO n{51pNE5 OCCUPANIL04D PASENENi —���— <br /> GPOII{' MFC114NIGL <br /> 3 IIVES I1 ND � --- _ - . <br /> FlRF:�IMM REOp PF4tio4 �UDIIIONAL PIAN CHCf.K <br /> _�__— <br /> Ot11E11 <br /> fiRFcp�INN1Ef1Rf0D RF�50N —_ - - <br /> Si�lEfl10l0iNG5U0f.11Aq6E ---' --- _`—/`� <br /> IVPFO�fDNVi PIAN54PPPpiFOpV ` <br /> J � CITY OF EVERETT rom u wnnnc � <br /> LOCAL CiALES --. _ _ - - _---- - ------. __ ______. _- :. . <br /> -- „�,E: C1�� /�;� _ TAX CODE IS 310_� ioin� - _--_ .!', �, ` �., . <br /> ---- -r- - - --. . . - -- - --� - . � <br />