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APPLICATIi �i FOR CON�TRUC'i ;JN PERMIT ��'"' <br />�����t„��n��•���� TO BE COMPLETED IN It?K—?LEhSE PRINT � <br />(,ItY OF }# <br />Q� V e Ce l l ' HEATING SYSTEM: GAS U ELECTflIC U <br />BUILDING DEPARTMENT - <br />259-6810 <br />enCNrtECT OR OESiG�1ER <br />�1FUEf1AL GO�l1RnClOn . <br />COMBINATION <br />;�..C�dnai� aooaess <br />��� ' <br />MAIL R DFE55 <br />MAIL PpDRE55 <br />IAAiL �O�AE55 <br />BUILDING <br />CITY <br />--CIIV " <br />$IP <br />ZIF <br />$IF <br />MECHANICAL <br />. _ PHONE <br />PNONE <br />Pf10NE <br />Pf10NE <br />�LUMBING SIGN <br />. /-Yl rll � <br />__ _'_ ""'___"__. _ —" _... <br />�.L n5S OF'NO�K <br />,� NEW ADDITION AITF.fiAT10N REPAIR DEMrOUTION WOODSTOVE/F(iPL INSERT � BUILDING PELOCATION <br />/ — If.ON1ACiFEA50t1ANDFiIONENO <br />\/ 7 q r I <br />CUNIRACTPRICEOFWGtiN OC �Jl�i __ <br />[lCSCRIBE WORK AND SOU4RE FOOTnGE INVOlVEO <br />I! GAL DESCAtP 110N O� �fU)�'I <br />�pi PLOCn <br />eEww o�t nt r <br />_ or _ <br />PIUMBING J <br />NO. TYPE OF FIXTUFiE OR ITEM <br />WATFF GLOSEI ITOILETt <br />-� ��HATHTUB -- — �--� �—�-.. ..� <br />LAVATORY (WASH BASIN) <br />SHOWER <br />� KITCHEN SINK 3 DISP <br />DISHWASHER <br />LAU�JDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />OFINKING FOUNTAIN <br />FI.00R DFAIN <br />BA.CKFLOW PREVENTERS <br />ROOF DFAINS—PAiiJLEADERS <br />SINK (SEflVICE—BAR, ETC.� <br />�L I HERE�Y CERTIFY THAT I HAVE REA� AND EXA�dINED THIS <br />�; �-`, APPLICATION AND KNOW THE SAME TO 8E TfiUE AND COPRECT. ALL <br />�� PROVISIONS OF LA'JJS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CO�dPLE7ED R'ITH WHETHER SPEGFI[D HEREIN OR <br />NOT. THE GRANTIIlG OF A PEFMI': DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISiONS OF ANY <br />OTIiER STATE OR LOCAL LAW REGl1LATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHCRIZED BY iHE <br />OWNEF OF THIS PROPERTY TO PERFORM THE WORI( FOR WhIICH <br />_ - APPLICATION IS MADE AND I COMPIY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 29E200 YJAC. <br />51cuAlunEOFcoNiRncronoRnutHOR¢EnAC,[ui on*E <br />/ <br />X /l1 G -,.. <br />__ —.i._ <br />0 <br />uo nnn ousinEss hnu[ <br />VIO. TYPE OF EOUIPMENT <br />� A:C—IvHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS�—B.T.U. M <br />C:.OTHES DRYERS <br />VE��TILATION FAN <br />FlANGEHOOD <br />J_ WATER HEAi"ER <br />WOODSTOVE <br />IdETAL FIRcPIACE 8 CHIMNEY <br />E%HAUSTFAN <br />SUB TQTAL $ SUB TO <br />.._._ __-- -_ PERMR _— $ .—__—__T_—.-_— ___ _._�—__._ PERMIT <br />--� - ---------iOTAI FF.E $ --- ' __� _— --�� TOTAL F <br />FOR OFFICE USE ONLY: <br />fltpfli5Ei8RCH RF�fl5E104CM SIpESET04CK PtANC11ECNNUMAER FEE <br />��urorve � �ot�ae� vncnmsne FEES VALUAI <br />DUILDING <br />. . 4�111� IYA'(11 ���f... ��'� <br />�.�ir�fr�1115uL.fWPPl1 hpf0{LOqSIAC111AI nfnli+4� � � <br />..°"��� P�UMB'NG <br />.__.."_. __—__'_____.__.—_ _"_—'_._.. _.—._ _ _—__ <br />',�IE Of OLUG NO OF S10�iE5 O�.�E�dFflf fdECHANICAI <br />_... "'_'__"'.__'._ '___--_'_--_'.____—__'. nDDI�IONALPLANCHECK <br />OCCUPpNGYLOAD FIRESPPNNlER5RE00 IIEIGNfLIM:1�110N <br />L_ OtHEF <br />�fASONFORSPRiNK�[�5 <br />STAiE BUIIDING SURCHARGE <br />.�nA+f Pv'�_ _� �—� nln�t;�v^npVE��V <br />i CITY 01 EVERETT runuc wonKs <br />LOC�L SALES <br />TAX CQOE IS 3105 rorn� <br />FEE <br />S �s� ; � <br />s �r ; <br />s r� — <br />iEGEIPI NO <br />FEE <br />----+— <br />f ; a� <br />