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1//.:; f <br /> APPLIGAT�Oti e OR CONSTRtJCTi� N P�RlVil`fi �'`°•"'" <br /> TO BE COMPLETED IN INK—PLEASE PHINT � <br /> . . .. �,•mrnn <br /> CITY OF <br /> everett HEATING SYSTEh1: f�GAS J ELEGTRIC J . — - - <br /> 4UILIJING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING X MECHANICAL PLUMBING SIGN <br /> P:lllER <br /> IARILAO�RE55 CIiY ZIP P���`� <br /> r�/� i 6 7/✓l °�77� iqC/i�V�i'�/•_' <br /> .�.��p��i 61qil.AO�RE55 <br /> cin ziP PMOnE <br /> ��n, Z�p PHONE <br /> nFCMtECTORDE9GNER MRILADDFESS <br /> c(n/EPAL�GONlTRAGTOB I.IAILA�OFE55 <br /> CiTV ZiP PNONE LICENSEt <br /> x r� I/�/2/���«tif 2�P PMONE LICEN E <br /> �T�;a VECHANICALCON!FACTCP MIILADORESS CITY <br /> ,o�x :inir.���z.✓c iz�s9l�o,a.✓v� /Eo.+z, �.t�or�.✓oi� 9�•5=7�L�s S.,�ir.�/�cis�'.'il <br /> 9 y y �'LU1A91N�3CONTRPCTOR MAIL PDOFE55 <br /> CITY ZIP PHONE LILENSE Y <br /> r .� <br /> H ^+' $' <br /> � Z� C��SS G`WORH - <br /> NEW ADDITION X ALTERATION � REPAIR DEMOLITION WOODSTOVE/FRPL INSERT 3UILDING RELOCATION <br /> � �Q CONTACT PERSON R1�PNONE NO <br /> � H� 335� �r -- <br /> y~ CCNiRACi PRICE OF WORK <br /> y z� DESLiiIBE WORK AND SOUPRE FOOtAGE INVOLVED <br /> � y ty Fc r.✓��cF rr�Ai✓Cv���v i <br /> O H vaoaoseouseoFoui�owc I HEREBY CERTIFV THAT I HAVE READ 4ND EXAMINED THIS <br /> H �g L/�I//�(�j �'�iiT �'4� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �" n IEGALOESCflIPTIpNOFPROPEPTV15110WN0ELOWORAiiACHFOU��APIE51 PFOVISIONSOFLAWSANDOROINANCESGOVERNINGTHISTYPECF <br /> �..� C� WORK WILL BE COPAPLETED WITH WHETHER SPECi!=1ED HEFtIN OR <br /> Z H 3, ip7 BLOGN oF NOT. THE GRANTING OF A PERMIT DOES NOT �hIESUME TO GNE <br /> � y�� AUTHORITV TO VIOLATE OR CANCEL THE �r10VISIONS OF ANY <br /> �..i y OTHER STATE OR LOCAL LAW REGULATING COfJSTRUCTION OR THE <br /> Cy fA H , PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 0 �� OWNER OF THIS PROPERTY TO PEFFORM THE WOFK FOR WHICH <br /> qq APPLICATION IS MADE AND I COMPLV W:TH THE STATE <br /> 3 C�C CONTflACTpRS LAW 1827 RCW AN�296200 WAC. <br /> L*1 C�7 SCd�niUREOfCC4TRACtOPORAUTHORiZEDAGENT OAiE ( ��—`�I <br /> z y cn <br /> HO[n <br /> X � � �y r <br /> -- _�"f.-_f' ,C'�l:!/>,'Y � s /'��<ti✓r�N" - <br /> rno�ecraoon=ss <br /> /TL S� n� � APr�Snr�iSGiI�U51uE5iLiCL'JSENOANpBU5WE55NAlAE <br /> ri <br /> PLUMBING MECHANICAL <br /> ��p, TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEHCLOSETITOILET� _ A�C—�HN�LGUNITS—H.P. <br /> � w� � t+ FORCED AIR S`!STEMS--B.T.U. M E.A. <br /> p BATHTUB _ -- —�— <br /> «w.o t — UNIT HEATF.RS—B.T.U. M � <br /> LAVATORY�WASH BASIN) — ---T-- <br /> SHOWER _ CLOTHES DRYERS <br /> -� w. KITCNEN SINK 8 DISP VENTILATION FAN <br /> �< � DISHWASHER RANGE HOOD <br /> � —— <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> �� vs 1dETAL FIREPLACE 8 CHIMNEY __ <br /> OR ' URINAL <br /> m����� DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> R , BACKFLOVJ PREVENTERS GAS PIPING <br /> .�_d� ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> ;�i —. <br /> C< -�— <br /> SUB TOTAL 5 SUB TOTAL 'S "—_ <br /> PE�iMIT 5 PERMIT 5 ' S ��� <br /> * ry� TOTALFEE 5 l"viALFEE 5 — <br /> FOR OFFICE USE ONLY: <br /> �Et aeceirrr�o. <br /> � fRONiSLT�ACK �EANS[TBACN SIpES[TBACN PlANC19G.1:"ACLrI <br /> u,ezone iornqeq vnenr�rsur FEES VALUATION FEE <br /> DUILDING <br /> IVPEOiCOt115A1L014ABLE IVPFOfWFL�TAGiOAL a¢��pa NodUwuu•;cu:ns — -- <br /> PLUM�ING <br /> ;REOFpIOG. NO.OFS'ORIES pASEMENT MECHANICAL � � <br /> A�OITIONAL PLAN CHECK <br /> OCGUPANGYLOAp FlRESPRNHVrl5flE0'D HEIGNTLIMIiAiION - <br /> OTHER <br /> —T_ <br /> PEASON FOR SPPiNRLERS <br /> STATE BUILDING SURCHARG� <br /> irunrcov PUNsnPrno�eoor CITYOFEVEfIETT puei.iCWor�KS �� <br /> LOC4LSALES � <br /> • � TAX CODE IS 3105 roTn� <br />