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APPLICATIA FOR CONSTRUC&N PERMIT " <br />TO BE COMPLETED IN INK -PLEASE PRINT <br />everett HEATINGSYSTEM: ❑GAS ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 879 <br />DEMOLITION COMBINATION BUILDING )MECHANICAL PLUMBING SIGN <br />OW HEn WI ADDRESS CITY I —. PP PJJIIE <br />TENANT <br />ZIP <br />CIrJ OF c-yCTLL-_T-T <br />ARCHITECT OR DEYGNER "t ADDRESS CITY LP PHONE <br />C"---C <br />GENERµ CONtRACTOR W&ADDRESS CITY ZIP PHONE LICENSE• <br />MECHI CONTRACTOR MAIL ADCHIM 1CITY ZIP PHONE LICENSE. <br />AIY Cn oT-Tr 1SlUL/A&7611 eeAluOT�d YY05Z 0,9i13 CC, RR,�R79 <br />PLUMBMOCpI1MCTOR MAR ADDRESS CITY TIP PHONE UCENSEA <br />CLASSOP WDRM <br />AACNEW )ADDITION (ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />CONTRACT PRICE aYgRK $327, Soo <br />LONTALi PERSON AND PIRINE N] <br />,ILcp 81-9533 <br />DESCRIBE VI ANDS ARE FOOTAGE IjjNV0.VED <br />� <br />'I— <br />PB 4�. <br />EDWEOF EDmG <br />(,1g (Z <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WI <br />SIGNATUREa LONTRACTCACRAUTHORODATE <br />XAT4, -�e '7- T/- 90 <br />APPLICANTSC SIN LICq NUSMESNWENCPRwo-z <br />LEGALDESCRIPtMN P ERIYISI SELDNOBATTACHFWRCCPIESI <br />LOi RLCCA v <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE. <br />NO. <br />I TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />S <br />NC-AMNDLG UNITS-H.P <br />BATHTUB <br />FORCED AIR SYSTEMS--S.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK& DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />I GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />I EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />ea Iu WE <br />7 <br />6 <br />SUBTOTAL <br />S <br />SUBTOTAL S <br />D <br />PERMIT <br />$ <br />PERMIT $ <br />1S AID <br />TOTAL FEE <br />S <br />TOTAL FEE S <br />VACANT SITE <br />BUILDING <br />fAX1E 410NABll 11R M1LDNEI µtUµ KnI,AATi IAPMun41n's <br />L0p'° PLUMBING <br />SMEOI I wDF STORA_s I IYISE.EHI I MECHAMCAL <br />I ADDITIONALPLANCHECK I I <br />OTHER <br />STATE BUILDNKI SURCWRGE <br />