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APPLICATIO "' OR f�`ONSTRI�CTI�I PERMIT everett <br /> �E�,p,� TO BE COMPLE7 ED IN INK—PLEASE PRINT � <br /> ,�;� everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ —1 <br /> : � BUILDING DEPARTMENT <br /> � � 259-8810 <br /> ❑ DEUAOLI710N I 1 COMBINATION I I BUILDING i I MECHANICAL Ll PLUMBING ( 1 SI(iN <br /> OWNEp GR.AIf� IMIL�DDRE55 CITY IIP PHONE <br /> ? gu�+�.+F`t Z$c�t Pnc��� /UF EvE�n 75r2o( 252�qVoc� ' <br /> 1 TENNIT .�r�� ��� �DD�E55 GITY 21P PHONE <br /> �� <br /> •RCPoTECTOq0E5qNER MML�DDf1E55 CITY ZIP PHONE <br /> owlJEtt <br /> pFNEWYCOf/TMCIOR IM0.ADORESS CITV Z1P PHONE LICENSEI <br /> � ��ll)�A Q ` <br /> -1 yEp/ Tql M�ILADDilESS LItY ZIP PHONE LICENSEI <br /> i <br /> � PLtIlMOCONTNACTOR /MRADDNESS CITY ZIP PHONE LICENSEI <br /> �.� <br /> I:� CI�SSOF�'Ni1K <br /> CI NEW I I ADDITION ALTERATION I I REPAIR I I DEMOLITION I I WOpDSTOVE/FRPL INSERT I_1 BUILOINO RELOCATION <br /> I ; CONUCT�P`EHSON�N�PNCNE N0. <br /> CaNTN�CT MICE oF Wa1K � � l7. t10J. l� � 1 <br /> i pElCpllEYqllKNqBqUREFODT�OE vOLVED <br /> w�rNT �a'fi! t t- <br /> �! ������"p I MEREBV CERTIFV THAT I HAVE READ AND EXAMINED TMIS <br /> _ ��Y APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �eokoescpm�ar�a (SNOWN BELOW OR ATT�CHFWRCOP 51 PROVISIONS OF LAWS AND ORDINANCES(30VERNINO THIS TVPE OF <br /> i <br /> � � � f� �lS �aK h`�p, o� _����� WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN Oli <br /> 'a _W�(_ NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> � AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTMER STATE OR LOCAL UW RE6ULATIN6 CONSTRUCTION OR THE <br /> ",� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> �� OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WHICM <br /> APPIICATION IS MADE AND � COMPLV WITH ?ME STATE <br /> �;i CONTRACTORS UW 18.27 RCW AND 298200 WAC. <br /> ;,i SNi/UTUREOFCIXITP�CTfMORAUi110RIffDiWENT DI11E <br /> i <br /> I � <br /> i�� �w��r evcnttc w.. X 9 <br /> M1D1E�T MDNE83 <br /> ` �PPLIC�NTS CITY BUSINE55 IGENSE NO.Nq BUSMF.89 N <br /> 'ti RUM�INO MECHANICAL <br /> t! N0. TYPE OF flII7URE 0111TEM FEE N0. TYPE EOUIPMENT PEE <br /> � WATER CLOSET(TOILET) � N�AMNDLO U TS--H.P. � <br /> ♦�' BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> t� LAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M ; <br /> SFIOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP � VENTILATION FAN � <br /> 'i DISHWASHER � RANOE HOOD � <br /> 'f LAUNDRYTRAY ; WATER HEATER ' <br /> �� CLOTMES WASHER � WOOD STOVE � <br /> � URINAL ' METAL FIREPLACE 8 CHIMNEV � <br /> � DRINKIN(i FOUNTAIN i FIREPLACE INSERT { <br /> �i FLOOH DRAIN � HEAT PUMP � <br /> �� BACKPLOW PREVENTERS � GAS PIPING ' <br /> •j ROOF DRAINS—HAINLEADERS � E%HAUST FAN � <br /> ,� SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> � i <br /> � � <br /> �j � � <br /> � � � <br /> � <br /> �,,i SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT S � <br /> TOTAL FEE E ' TOTAL FEE f � <br /> i� FOR OFFlCE USE ONLY: <br /> i�. FRd/TSEiBACK REARSETBAGK SIDESETB�CK P�ANCHECN UMBER FEE (J` RECEIPTNO. <br /> — �C�5'rt�1Gr — 7� �' <br /> USEZCXIE LOTAREA VAC�Ni51TE EES VALUATON FEE <br /> , � —� � BUILDIN i <br /> � TYPEOfC01itSALIOWABIf i„WE1OfCOMSt.�LtU�I anrn.Mcr woaowtunqurms , <br /> },� �XIS 11`Y v p� – `�� PLUMBING ; <br /> � 8 OFBL00. NO.OfSTOAlES BASEMENT � <br /> �G N� MECHANICAL � <br /> % sT � <br /> OCCURWCYLOAO FIRESPPNNLERSREO'D HyEI NtUMI1A1tON AODITIONALPLANCHECK � <br /> (,/p Gk�ArIG . �v G![I�T �G • OTHEH ; <br /> NEASONFOFISPPMIIERS <br /> .' STATE BUILDING SURCHRRGE i <br /> i <br /> RITAKEBV VLANSAPPRO DBY CITYOFEYEHETT PUBIICWORKS �� <br /> ; LOCAL SALES <br /> TAII CODE IS 3105 Tor�� � <br /> i • - - <br />