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�n� <br />p�x <br />�H� <br />H��-�+ <br />�t ci <br />H x) <br />�C~/1H <br />� 0 � <br />OH� <br />H�g <br />�i]Y (i <br />t+y� <br />f�i� y <br />gCCd� <br />Z y y <br />HOCn <br />�� � <br />�� <br />APPLICATIOf. �FOR CONSTRUCTIc�"�1 PERMIT <br />;, . TO BE COMPLETED IN INK—PLEASE PRINT <br />cn�� ni <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />Lv'efcll <br />e <br />HEATING SYSTEM: � GAS ❑ ELECTRIC C.1 ______ __— -__ <br />DEMOLITION COMBINATION <br />�'.�n.cfAL7� �I10/Q�ir�anoo�s�f� '%S`�o <br />OR�ESIGNER 1AAILAODNE55 <br />BUILDING <br />cirv <br />ZIP <br />MECHANICAL <br />PHONE <br />PLUM2ING SIGN <br />_S7 �� <br />(; �PRLCONIR/�1C���C�A�� pDOHE55 GiTY ZIP PNONE LiCENSE� <br />/YysnaL ���J�', %5'� L�'-�Ez'cf �'/ f�:��� iy'7-S.� 3D <br />A�ECNANICqLGONiRnCiOii NAILAOORE55 CItY ZIP PHONE LILENSE/ <br />PLUM1�BING GUNTRACTOR M�IL ADDHE55 GIiV ZIF PHp1iE LICENSE M <br />CLASS Of NDPN <br />x NEW �. ADDITION � ALTERATION REPAIR OE1dOLITION . WOODSTOVEiFFPL INSERT ��. BUILDING RELOCATION <br />: f W Cl �PICE OF <br />;RiOE WL°K ANI <br />4'%1L� fiS <br />LEGr1L �ESCR:PTiCN OF PROPI <br />LOT OIOCK <br />. , _ _ � <br />� <br />���O�CCTADDRE`.'.5 <br />�401 N <br />bqs <br />7 <br />.irrvo�veo � <br />���� <br />� <br />IWN DEIOW OR ATTP <br />OF _ <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORV�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 �ISP <br />DISHWASNER <br />L�UNDRYTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAWLEAC <br />SINK (SERVICE—BAR. ET( <br />SUB TOTAI_5 <br />PERMIT 5 <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />ii�JNiS[iOACN REARSET(IAGK <br />ao� a�' <br />USL]G6=� IOTARER <br />I��1�� <br />Ivri tl{- �COyt'115 AIIOW�BIE IVPE Ot LON51 FLtI <br />.. _ ..V-" � � <br />s�r�. or mnc e�o oF sronies <br />^u4Z iF t5� <br />r: cn�;,4qf�1� � <br />OCGtIPANCVlOAO �IRE SnRNrciERS <br />� TJ/A No <br />mi,:ni uv <br />ov <br />$IpE SEi�A-K � <br />COYTACi P[ii50N RND PNONE NG. ,r , - <br />p2/'ort ,3 � � -So�.30 <br />� Gr 35S - <br />,n MG n��•llL9lCfPl'Io/�PI.n� 2.N3(o <br />I HEREBV CERT Y THAT I HAVE READ AND EXAMWED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />— PROVISIONS OF LAN'S AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COM1IPLETF.D WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIt�G OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OF ANV <br />� OTHEfl STATE OR LOCAL LAVJ FiEGULATWG CONSTRUCTION OF THE <br />PERFGRMANCE OF CC�NSTFU�TION. THAT I AM AUTHORIZCD BY THE <br />OWNER OF THIS PROPEFTY TO PEFiFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA S LA 27 FCN' AYD 2962U0 WAC. <br />SIGNAID OK NiRR ORG9 i�LiFIZEDAGENT D�TF <br />X v� ' � � �-/ 7/v <br />Aop�iCANTS CIiY 13JSINESS IILENSE NO. ANO 9U5'kE55 Yr1ME <br />VDLG UNITS—H.P. <br />AIRS`!STEMS—�.TU. M E.A. <br />UNIT <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSEFiT <br />HEAT PUMP <br />GAS PIPIN6 <br />E%HAtIST FAN <br />SUB TOTAL 'S <br />PERMIT S <br />TOTALfEE S <br />NUMEER FEE /.G <br />� i�n / ( �� `-f � 1 �.� <br />ouaoiNc �"s ov ir�s <br />oa�r.n:. uono-xmna��::s [rv:.���. <br />`0�" PLUMBING <br />Q� � <br />BASE�ENi MECNANICAL <br />NO <br />��EiGirtl'uL�9Tiorv AOnITIONALPLANCHECK <br />� CITHER <br />S1ATE BUIIDING SURCHARG[ <br />CITY OF EVERETT Fueuc wo�ks <br />LOCALSALES <br />TAX CO�EIS 3105 TOTAL <br />n <br />