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APPLICATIQ�' FOR CONSTRUCT' 1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8870 <br />❑ DEMOLITION ❑ COMBINA110N �BUILDING ❑ MECHANICAL ❑ PLUMBIN(i ❑ SION <br />MAILADDRE55 CITY ZIP PHONE <br />r' ..� .1 0� �''/,..dLC 30 U/ /�/<<w! fJ� E✓�--•A` 9F�o/ ZSS — 2 S9 / <br />7�IIµT W0.ADDRESS CITY ar rmmc <br />ARCHRECTORDE516NEN MN�ADDNE55 CITY ZIP PHONE <br />�A <br />va1�c <br />7, 60�, ': <br />�„�� �T,� �� <br />� nnovasEnus�� <br />I�a�u oeecnwraN a v <br />' '1► ss s 3 2 y, <br />� LOT a <br />i —_�� <br />PARCELTNfI.D.NIMIBER <br />CONBI�M1CilON LON/ lEl <br />� <br />SINK 8 <br />7EtEPlIONE qUTABER <br />PERMIT <br />TOTAI FEE <br />FOR OFFICE USE ONLY: -- <br />FnoNr sere�cK �w sEre�ac <br />{�E ZqE l0T �REA I <br />TY140FW16f. ND.OFSTORIES <br />eQE OFlLDO. <br />FIRE SPHIM(LERS REOD <br />INi�KE BV � �� ���VED BV <br />wre <br />4 ZO <br />cm <br />cm <br />rn rrune <br />+4 Si S w E. <br />ZIP PNONE <br />ZIP PHONE <br />SiATE ICENSE � <br />/XOJ�N�/ G/ /DO D-'g <br />STAtE LICEN9E I <br />1 HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES (�OVERNINCi THIS TVPE OF <br />WORK WILL BE COMPLETED WITH NM1iE7HER SPECIFIED HEREIN OR <br />NOT. THE dRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW RE(3ULATIN(3 CANSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFiORRED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITM THE STATE <br />CONTRACTORS LAW 1827 RCW AND 298.200 WAC. <br />� ..`11'/!UlNEeSt5Ex9Ew. <br />���L <br />E NO. TYPE OF EOlNP1 <br />� M�AMNDL6 UNITS—H.P <br />' FORCED AIR SVSTEMS—B <br />, UNR HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANOEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />� METAL FIREPLACE (W000 <br />, FIREpLACEINSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUST FAN <br />v�cu+r si� rees <br />❑ YES ❑ NO BUILD�NG <br />aw»uar xo a vxnuxe u�rts <br />cnav PLUMBING <br />B�SEMENi MECHANICAL <br />❑ YES ❑ NO <br />MEIGNTLIMITATION ADOITIONALPUNCHE�K <br />OTHEfl <br />STATE BUILDING SURCHARGE <br />CITY wO-F1 EVERETT PUBLIC WOFiKS <br />L��ML ��8 <br />TAI( CODE 18 3105 �TAL <br />SUB TO' <br />PERMIT <br />Ei <br />H <br />� <br />