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APP�ICATIO./ FOR CONSTRUCT.JN PERMIT ������t <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />lhe Evergmen <br />GTV OF <br />everett HEATING SYSTEM: GAS ❑ ELECTRIC ❑ —� <br />BUILDING DEPARTMENT � <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />OWNER lAAILADDRE55 QtY ZIP PHONE <br />���. v����� �szv b'��� .������-" �ro zo� zS-z - y oi 9 — <br />TENFNT � MlILAD�RE55 CITV 21P PMONE <br />o-� 'Dl�ce: 3sZ� /��Y6' �U2�--�.- ��s-- So 5�/ <br />/RCMIiECTOROcSIGNER MAILADDRE55 CIiY ZIP PHONE <br />GENERILCONiRACTOR MAILA��PESS C17V 21P PHONE UCENSt• <br />yKn. <br />AfE HANICALGONTRACTOR MAILADDRE55 Cltt ZIP PHONE LICENSE� <br />PLUMBING LONTPACTOR M�IL pDDRE55 <br />CLASS OF WOPK <br />�. NEW � ADDITION ALTERATION <br />CONTFACiPRiGEOFWORK �/� <br />DESLP13E WORN AND SOUAPE F00 AGE INVO�VEO <br />PFOPOSEO USE OF BUILDING <br />cTYN6L� /C1 <br />L,E�G � �ES�C,RIPTION Of f'ROPE�. <br />,�- �z <u <br />LOT BLOCK <br />/�iC/ 02 ;' �J' <br />� U��t ec� <br />CITY <br />PMONE LICENSE� <br />REPAIH DEMOLITION . WOODSTOVE/FRPL INSEP,T ��. BUILDING RELOCATION <br />' CONTACi PERSON AND PHONE NO. <br />Sro c� o� �i��- 2sz-5�vs u-� <br />713 � � u `!�/ BIY; <br />.rYy-�Co /tYJ� <br />/(Q_�.-�G-Ji^i aG <br />BELOW OR ATTAGN FOUR COPIES) <br />OF <br />l,r.C^ 2Ooid/o--� �2� <br />3s�2� .dioY� av�. <br />iOJECTqDOFESS <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />& DISP <br />LAUNDRYTRAY <br />Ci_OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW PFEVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN FEFR SETBAGK <br />USE ZOtIE <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />SIOE SEiBALK <br />VAGANT SI1E <br />iYPEf,iCONiS.AIIOWA�tE I iVPFOFC@AiACiUAI <br />_�l� �-n1 <br />512E OF BL�G. NO OF STORIES <br />S�'1 Sf REP�I�L _ Z <br />OGCUPANCVLOAD FIRESPRNNLERSREOD <br />Iu�A AL' <br />f±EASON fOR SPRINKlERS <br />WTAKE BV PLANS APPROVED �Y <br />�� <br />xo oroxEwr�c utiirs <br />V <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE �AME 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 18.27 RCW AND 296200 WAC. <br />SIGNATURIiOFCONTRqCTORORAUiMORIZEDFGENT O�TE <br />'�z�� �Z� -- <br />APPLICANTS CITV BUSINESSLICENSE NO. I1ND �USME55 NnlAE <br />NO. TYPE OF E�UIPMENT � FEE <br />FORCED AIR SYSTEMS—�.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIflEPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />FiEAT PUMP <br />GAS PIPING <br />EXHAU51"FAN '' <br />SUB TOTAL S <br />PERMIT $ <br />TOTAIFEE $ <br />PLFNCMECHJJUhIBER � FEE <br />0 <br />BUILDING 35 , <br />PIUMBING <br />MECHANICAL <br />�ggHigNqrpLAN CHECK � � � <br />OTHER <br />SiATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />