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/ APPLOC/�T10��' FOR f�'ANSTRIiJCTI„!N PER'MIT everett <br />fheEvergreen TO BE COMPLETED IN INK—PLEASE PRINT � <br />CI7V OF <br />everett HEATING S"STEM:�.GAS ❑ ELECiFiiC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />f7 DEMOLITION i i COMBINATION ! BUILDING ' MECHANICAL I!PLUMBING i SIGN <br />OWNER � MAII ADDRESS 1 LI y � I/ -�� N � PIION ^� _� � <br />n�YUI 1 i{v-t�111/1 _�( 1!`l) �. �F�f i Y Lli\ � C�%�J/%� <br />I TENANT �/� \ /� _ <br />J�J�/ Y <br />ARGIIITEGT Oq �ESIGNER <br />P�UMOING LONTR4GTOR <br />anss oF wonK <br />I � NEW f 1 ADDITION <br />CONTFACT PPICE OF WORK <br />USE OF <br />■ �or <br />� PR0.1EG1' RODRESS <br />6LQ:K <br />8 <br />MAIL ADORE55 <br />CITY 21P PNONE <br />CITY ZiP PHONE <br />�-_,��Q/.���Ln ,��' � �1/ l`11,/- .� 'S`d� <br />MAI�a00RE55 GTV � iP, , _ � n� f ;��� �(;ENSE� / � ^ <br />l� i 1 C� �'� <br />UMLADONE55 CITY ZIP PHONE UCENSE� l <br />)/�TERATION I I REPAIR I', DEMOLITION I 1 WOODSTOVEJFRPL INSEHT !�i BUILDING flELOCl�TION <br />'�S`/ �, I CONir1GTPERSONAN�CHpNENO. <br />V V <br />4.SE IiJYOLVED r` <br />n1�11/, ��Ih/�l Q n <br />CLCTHES WASHER <br />UHINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAI'J <br />BACKFLOW PREVENTEflS <br />ROOF DRAINS—RAINLEAC <br />FOR OFFiCF USE ONLY: <br />!'iIONT�ETIIAGN RE�P' <br />I HEREBY CERTIFY THf.T i HAVE READ AND EXAMIIJEC THIS <br />/ APPLICATION AND KNOV✓?HE SAME TO BE TRUE AND CORRECL ALL <br />LOW ORATTACII FOURCOP�ES) PROVISIONS OF LAWS AND GPDINANCES GOVERNING THIS TYPE OF <br />INORK WILL BC COMPLETED WITH WH[THER SPECIFIED HEREIN OR <br />oF MOT, THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOL�TE OR CANCEL THE PROVISIONS OF RNY <br />OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION OR THE � <br />?ERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWN"�R OF THIS PPOPERTV TO PERFORM THE WORK FOR WHICii <br />nPPLICATION IS MADE AND I CO�APLY WITH THE S7ATE <br />CCNTRACTORS LAW 1827 RCW AND 29fi200 WAC. <br />SiGN��UREOFpONTRA�TO00R�UTHONIZEDAGBNT DRTE <br />�L �4-J — ��r `�'�"�o`� �Ze _ �Q�'_���U <br />� A LICqNiSCITV8U51N SUCENSENO. NDBUStNF.SSN�,ME <br />MECHANICAL <br />R ITEM17 FEE N0. TYPE OF EOUI?MEt�T FEE <br />USCZONE IOTMEA <br />I1YPCOiCONiSf.IIOW�BIF 7VPEOiLON57ACIUAI <br />SIZEOFBLOG. NO.OFSTORIES <br />OCCUPANCVLOFD FIRESPRNKLEflSREOV <br />F{ERSON FOR SPRINHLERS <br />INTAKEBY PLFNSPFPROVEOBV <br />FORCCD AIR S`!STF!SS—B.T.U. M <br />UNIT HEATEfiS--B.iU. A1 <br />CLOTIiES CHYERS <br />VENTIIATION F�N <br />RP.NGE HOOD <br />WATER HEATER <br />WOOD STOVF <br />M[TAL FIREPLACE 8 CHIM�EY <br />FIREPLACE INSEFT <br />hIEAT PUMP <br />GAS PIPING � <br />� SUBTOTAL S <br />PERIdIT 5 <br />TOTAL FEE $ <br />Pl RR LMECN 1lUh!BEN RECEIPT NO <br />eui�oi��c <br />OCCUP�NLY NOOibMIUNfiUV115 <br />GRWP pLUMBING <br />BASEn1ENT MECHANICAL <br />NEi:HT�IM17RT�ON ADDITIONAI.PI.ANCHECK <br />O7HER <br />£TATE BUILOINC SUFCHARGE <br />CI7Y OF EVERETT pUBLIC WORKS <br />LOCAL SALES <br />TAX COUE 15 3105 TOTAL <br />FCE <br />� <br />� <br />G <br />: 4 <br />��� <br />