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APPLICATIa J FOR CONSTt;UCT�JN PERMIT ���'P�t <br /> mee�e.Q.een TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> �n� eve rett HEATING SYaTEM: ;�GAS ❑ELECTRIC ❑ <br /> �'� BUILDING DEPARTMENT <br /> D x ^ 259-8810 <br /> ��y DEMOLITION COMBINATION XBUILDING MECHANICAL PLUMBING SIGN <br /> pWNER MARAODFE55 CITV ZIP PHONE <br /> k � ALFREC:� Ii.AI��iW� 74OZE Hf-ATNE�'W/�4' G�'E�'TT' AS�203 3_53-9.53 U <br /> oH r�L iENANT I.IAILA�OBE55 CILV ZIP PNONE <br /> 'iIH� <br /> y qaCwTECTOR0E5iGNER AIAI�ADDPE55 CiiY 2iP P�ONE <br /> yx <br /> �o /!/i-RED '2 hl°Cd(hIF_ <br /> �]tJ GENEFALCONTRACiOB MAIL�ODRE55 CIiY 21P PHONE LICENSEA <br /> ��g n�r-�E� i� n��curc� <br /> MECHANICALCONTRACTOR MAILADDR[55 CITY 21P P1101lE LIGENSE• <br /> �Y (� <br /> /Vd A.�L <br /> y PWfAdINGCONiRACiOR IA�ILPODRE55 GITY ZIP PHONE UCENSE� I <br /> xH — <br /> �Hy nivti�� <br /> tyy c�nssorwoAK . <br /> �d y . NEW XADDITION - ALTERATION � REPAIR DEMOLITION WOODSTOVE/FRPL INSERT . BUILDING RELOGATION <br /> �C � � en� /dI �"��' C0�1iACTPERSONANDFHONENO. <br /> �� i/'7-.+-c� II <br /> WNTRnCT PRiCE OF WORN <br /> Qy OESCRIBEWORKANp50U/PEFOOTAGEINVOtVED �1 � � �lOdJh � � <br /> _. CA2 �al�r-3•� � n �r I �� , <br /> raovoseouseoFeui�oirvc I HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS � <br /> D TJ�GJ TU N'OM r._ ���` APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL ' <br /> �wn�oescnianor�oFVRovearv�sHowrvee�owoRnrrncNFouacoaiesi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> C�1 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> wr� BLOCK�U �D—O�OF `�L T NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE ��. <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV � <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF TNIS 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 /> $IGNAiURE pgq�ONrq�C�tORoA AUiNO ❑AGENT �ATE <br /> X �///� /�/i.l �1,f F ,_Cs't—� / <br /> !G y/c.�'vl //( � n.I/%/ <br /> - vao�ec*noonEss � / <br /> " � U� �• I'f IsAT���WI�'� APP��CANTSCITYAUSINESSLICENSENO.ANDBUSINESSNAME <br /> 1 ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� lvC—NHNDLG UNITS—H.P. <br /> , 1 BATHTUB FOACEDAIRSYSTEMS—B.T.U. M E.A. _ <br /> LAVATORY(WASH BASIN) UNIT HEATEP.S—B.T.U. M <br /> '�I SHOW ER CLOTHES�fiVER5 <br /> KITCHEN SINK 8 DISP VENTIIATION FAN � <br /> 1 DISHWASHER RANGE HOOD —r <br /> ' LAUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> �� URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACEINSERT <br /> �' FLOOR DRAIN <br /> HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> �e ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> � SINK(SERVICE—BAR,ETC.) <br /> �' — <br /> '! <br /> ' SUBTOTAL S _ SUBTOTAL S <br /> � PERMIT 5 PERMIT S <br /> TOTAI FEE 5 TOTAL FEE 5 <br /> fOR OFFICE USE ONLY: Y <br /> FFONiSEiBACK R[4FSEiBdCK SIOESEiOACK PLRNLNEC NUAIOEP FEE �EGEIPTNO <br /> Z,p �P �,' S ' 9i aG3�Y ( 93 �o ys-� � y � <br /> usezorvE �oraaea wcnNls*[ FEES VALU�TION FEE I <br /> �I N�� �� �•� �� BUILOING 3 'L /s3 ;Od ' <br /> IVPEOILpNiSPIIOWABIE IYPEOfCCflSiAC;IIFL o[Lu�amcr xOa�pHi�.uN4uNi�5 , <br /> � eaou� � PLUMBING _ �. <br /> -iJ - <br /> Si1F.OFpLDG NOOPSTOFiES BASEMENt MECHANICAL � <br /> IqZ Sf ADD.1 ' <br /> ?EH SfCAFpo[7' : D- � Z NV <br /> OCf,OPANGVlOAO FlflESPRNNLER5RE0'0 M[IGHTLIMIiATION AO�ITIONALFLANGHECN s ��� <br /> ♦ <br /> I�I�q UJ � OTHER ' <br /> REASON FpR SPtiINNLERS —� <br /> STATE BUILOING SURCHARGE � �� <br /> INTAME�Y PLANSAP^ROVE�BY CITY OF EVERETT PUOLIC WORKS I <br /> � ���� LOCAL SALES � <br /> -,��Z TAX CODE IS 3105 T�TAL �L ,� ;3'_� <br />