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Y <br />APPL.ICATIC4 <br />FOR CONSTRUCT19N <br />PERMIT <br />rtH�t Hnq.PPR TO BE <br />COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett <br />HEATINGSYSTEM: ❑GAS ❑ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />-- <br />259-8810 <br />DEMOLITION -. COMBINATION <br />BUILDING MECHANICAL <br />XPLUMBING <br />SIGN <br />OWNER iADDRESS <br />CITY TIPPHONIC <br />Pic, &7: u a, <br />-r Air. &E c �fi 44eb r <br />TEIVINIT w <br />I PHONE <br />ARCHITECT OR DESK.NER WI ADCI <br />CITY ZIP pW,[NE <br />GENERA- CONTRACTOR YAIL ADDII <br />CITY TIP PHONE <br />LICENSE• <br />c<<< Qp..s71 �x <br />1 rcag5,; , <br />4ECN.VIIC4 CONIM[lOR iADDNE557 <br />CITY ZIP RgNE <br />LICENSE• <br />RNIBINGC 4ALFFtF55 <br />CITY ZIP PNDNE <br />LICENSE• <br />a jTCT0R <br />UZ.8tj<II Nl�cal f'o.bmr iis�� <br />1 <br />NLY 5Nf ISO, 2Gi/a 84a•oar>S <br />wss a vgRN <br />X NEW JC ADDITION ALTERATION <br />REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />yi <br />Ca1TMCi PRILEK WORN db <br />CONTACT nll p MIT Fpci NO <br />DE7;WCTIX/1A�NPSOVANE FOOTAGE W VQVED <br />/A <br />P710:OwEDFeU AD <br />�.7 i2 L+H.� y 4.9. If./ FEw a eY �ocQ -P <br />1 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 10.27 RCW AND 296.200 WI <br />SoNAA/"R/REE.�Of'CONTRACTOR OF AUTHORIZED AGENT DATE <br />--xH/!ICI <br />✓ <br />¢GAL ME RIPr OFPRDPm•SHOWN pv. oR AnACRF RCpPIE51 <br />LOT BLOCK of <br />f1161E(.T AppRE55 <br />FI �` <br />SpIc L <br />Al ICAN15CIlY SME55 LCENSE NO AND &r$ME55 NAPE <br />WAN <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />ABC—A/HNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS--STU M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A 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 A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL E <br />SUBTOTAL S <br />PERMIT $ <br />PERMIT f <br />TOTAL FEE $ <br />TOTALFEE f <br />FOR OFFICE USE ONLY: 1.1.5a.31 <br />FRONT SEIRACK <br />REAR SEIBACN <br />SIDE SETBACK <br />RNIaECRNUYBER <br />FEE <br />RECEIPrm <br />USEZOME <br />to: AREA <br />YACHT WE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYR acpRIS NIDWMIE <br />lm OF END, ACTUAL <br />1am«An <br />"Pi <br />nWaluAcu-: <br />PLUMBING <br />SME0,111m <br />ND 01"WORF9 <br />BASEMENT <br />MECHANICAL <br />CCCIMAICY LOAD FIRE SPRMLERS REOD HEIGIITLAPTATM <br />RE45ON F W SPILAI <br />ADDITIONAL. PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />N*AKEBv <br />RAMS APFROrEDRv CITY OF EVERETT <br />LOCAL SALES <br />TA%CODE IS 3105I <br />PUBLIC WORKS <br />Tout <br />, <br />