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APPLICATIO. FOR CONSTRUCY[ N PEIRMIT <br />TO BE COMPLETED IN INK-PLEASE PRINT <br />Ifm E'e�9�ran <br />CITY OF <br />everett <br />BUILDING DEPARTMENT <br />H10 <br />_ . . _ _ . _ _ _ _ _ _ ' _ _ <br />HEATING SYSTEM: �'�-GAS I,� ELECTHIC _ IJ _ _ _ _ _ _ <br />- - ----- -- - . .. . <br />I.. ---� �--- <br />259-8. ` /. <br />BUILDING ECHANICAL PLUMBING ' SIGN <br />DEMOUTION COMBINATION � _J� _ _ __ __ —__ -- <br />OWNER/ I.IAIt AD�RE55 CC11Y ��--� "� �� LII• PIIONE �,�� <br />1L SG N �` 9O� �����G l�C'��-- —¢!2��—¢�O—Z_ _— � <br />IENAt LiAILA�DRESS CiTV ZIV PNONE <br />5',��r e .ciS' ,G.�iv�e_ — <br />ARCHITELTON�ESIGNER IAAILADORE55 <br />C11V ZiP PI�OFE <br />/%/o.vP� _ <br />GENERRL WNTRACTOR i��All AODRESS <br />CIiY ZIF PI101![ LICENSEI <br />MECMRNiCRLf.ONTRRCiOR IAAILA��RESS / GiIY /ZIP PHOIlF. IIGEl�SE• <br />..��....Lf�r.rnr�rae� A/ IAIIA(1�NES5 ie.Ltl��SCi�—T_QSN�! I��✓� ��5��/�J�� <br />GIIY I��' PIIONE UC[NSE� <br />LLr155 OF NDRN ' <br />I I NEW I i ADDITION ALTERATiON �_REPAIR I I DEMOLITION '. �� WOODSTOVE/FRPLINSERT I i BUILDINGRELOCATIO <br />�� C.OtliAC f VkNS011 ANU 1'l l[)NL !10 �— � /��'//)� <br />(J!! ����/ �� <br />GONLRACT PNiCE OF WORN <br />/ �0�. �GQ <br />OESCRI[1E WOf K ANO SGURRE �OOTAGE IIlVOLV1E� `/,// /� � /� � �'/ <br />�I lo.afiT �=G�S��.•__LG 4.d .: �7' G�' —T_'� � _ <br />rnnvnseou5l:oFUWIeiNG I HEREBY I:ERTIFY THAT I HAVE HEAD AND El(AMINED THIS <br />IEGRi.0E5GRII'JION UY YHUrt <br />LOT __ BLOLN <br />noories.s <br />FIXTURE <br />W�\TER <br />SHOWER <br />KITCHEN SINK 8 DISF <br />DISHWASH[fl <br />LAUNDflYTRAY <br />CLOTHES WASHER <br />DflINKING FOt <br />FLOOR DRAIN <br />BACKPLOW Pf <br />ROOF DRAINS <br />SINK (SERVICI <br />�/r. l APPLICATION AND KNOW THE SAME TO BE TRUE ANG CORRECT. ALL <br />.owoRRTTAL'�FOIIPCOPIE51 PFOVISIONS OF LAWS AND OFDINAtJCES GOVERN�NG THIS TYPE OF <br />WORK WILL BE COMPLETED WRH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LA'N REGULATING CONS11tUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM1; AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />— APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAfTORS LAW 1827 RCW AND 296200 WAC.L//3' m <br />— svrmiunc` r,u�aaonori �11o�+'zeuncEr�r onm � �/ <br />/l��/% /�� . i / <br />FEE <br />FOR OFFICE USE ONLY: <br />�qONi SETflACK REAR ;[113FCK <br />uS[ ZONE I.OT ARFA ---- <br />lYP(0lCONi5Ul9WABlE !'/FEOFWNSiFLIIUI <br />SIZ[ OF OLDG NO OF Si0RIE5 <br />OCCIIPANCVL0A0 FIPESPRNNIERSREQ'0 <br />RE�SON FON SPHirvnitns <br />INiANEBY PLANSPPPROVEO <br />$ <br />nrrucnNt s�Q1�ui �si�+Ess � icros[ no <br />FEE I N0. I TYPE OF <br />A�C—A/HNDLG UNITS—FI.P. <br />� FORCED AIR SYSTEIdS—B.1.U. M <br />UNIT FIEATERS—�.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGE HOOD <br />_!— -WATER IIEATFR __ _ <br />WOODSTOVE <br />h1ETAL FINEPLACE 8 CIiIMNEY <br />FIFEPLACE INSERT <br />HEAT PUMP <br />j GAS PIPING <br />E%HAUSTFAN _ _ <br />-- p�AIICULLNI1111.10[R I �E[ <br />vncu+rsire FEES VALUATION <br />�llll UINC <br />�kliif�l6v NOqVHiuiLLbr.i13 ---.._._-- _----- �- <br />cT� ° PIIIIAIlI�JG <br />OASCMCNT Id[f.IIANIGAL <br />❑[IGIITIIIAITATION FODITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT Pl10LIG WOPKS <br />LOCAL SALES <br />TAX CO�E IS 3105 TOTA;. <br />$ <br />S <br />a <br />1': <br />