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�"� PCl'�PII <br /> APPLICATIG.� FOR CONSTRUCI .JN PERMIT � <br /> TO BE COMPLETED IN INK—PLEASE PRINT {� <br /> tne Evero��nn !i <br /> QTV OF <br /> everett HEATING SYSTEM J GAS J ELECTI�IC J _ � <br /> BUILDING DEPARTMENT <br /> 259-8810 . <br /> DE�AOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> O NEP 1.41lADbRE55 iY l�� PNONE ^�. ��^� <br /> �n`n� g3�ul ��� c <br /> �� �1oe1a c�a a�31 �1e��mn�___ u_ o�oNE <br /> iENaryl\^ AIAILA�DflE55 CIiV %P • <br /> v o '10��0`'4� <br /> n 'n1ECtORD GNEP A�diLpD�RESS <br /> _ c �e��el�� aa�6 3�d '�u�, �eUll�� ��ia i � <br /> r�� �y/J/�F Pcr {� `� �Z�201 `�95-8►►� �,�«,sEi�v�107 66 <br /> ('�NLPALC NLPACIO AD�RF55 (� <br /> ��� U��U���I�i11 1L_1Cr FU �� l� � I� PHONE LICENSE , . . <br /> VCOIAHIC�LCJNLPTCiOR IdA1LA00AE55 C11V ZIP � <br /> y U—��5�PA4J�F.��1-� , 1, _:`- : <br /> �'LUMpINGCON1ROCiOP ,1MNLADOFE55 �� OtV ZIP PHONE IICENSE• I � 'I <br /> a�y 11 „ r. <br /> H .� CLa550F WORK <br /> y �H NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br /> yC y� ✓� r CONTAGTPERSONRNDPNONEHO. <br /> � H� CONiRAGT VRiC[OF NOR � l If1�/o o — <br /> [n H 0 SCRIp[\ fl A�0$OO�RC FOOTA.[iNVOIV[y <br /> ♦ <br /> � �� ���" ,��� 1��d110 C V' <br /> Q� c–r7pwseous�orm r.+c 1 �� 1(�(',5 J I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ry c��,��� "'1 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> C/1111�\ PROVISIONS OP LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> H �g L[GAL�ESCRihiIONOFPROCE�T�'I5� �wr+oe�owoanrrAui�ou�acomes ydORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> L')� O �o��' g�p��_. �� NOT. THE GRANTING OF A PERAtIT DOES N0T PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> y y� �� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> t'� H y PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �y � 1\ �I PC�IC/ OWNER OF THIS PROPERTY TO PERFORM THE VJORK POR WHICH <br /> p �H APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> O C7� CONTR CTOR LAW 1827 RCW AND� 96.200 WAC. <br /> � 5� SIGNATU OFCOtRAG10R RAUTMORiZED ENT Dn1E <br /> l•1 <br /> H O y X � �\n � <br /> 1C <br /> P OAJECtADD 55 I A1/V pppLIGANTSCIiV�USItiE55LiCENSENO.l1. BUS�N SSNNM[ <br /> PLUMBING v��Jl MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> / WATER CLOSET(TOILET) NC—A�HNDLG UNITS—H.P <br /> 'e � <br /> � BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> 1� LAVATORY(WASH BASW) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRVERS <br /> KITGHEN SINK 8 DISP VENTILATION FAN _ <br /> "" � DISHW�SHER RANGE HOOD <br /> i �' LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE �_ <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> �' <br /> � I DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> � 1! ROOF DRAINS—RAINLEADERS EXHALIST FAN <br /> � SINK ISERVICE—BAR,ETC.) <br /> —� <br /> �~�� <br /> SUB TOTAL 5 SUB TOTAL J <br /> — PERMIT S PERMIT S <br /> �s TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> S��E SETpRCN� FIAN CHECn NUAIBER FEL RECE�Pi NO <br /> rnar+�s�ioncK � nenascioncn �7/ P 7J .'�3 �P/ <br /> �� p' S 90 �S !3/ <br /> vnc�Nrsrte FEES VALUATION FEE <br /> UtiE ZOt!� ` LOi AREA��,/� �J � <br /> /�, {yJ.+ �ro BUILDING �1r5� J� ' � <br /> PIP[�i GONI$0.11OWRPLE 1YP(0(COIiSI A�OAI M�OU�� FO Oi pNlu'.lbi•��5 � i <br /> / PLUMBING �. <br /> Si][OFBIDG NOOFSTORiES RSEMENL _ 61ECHANICAL <br /> � �J <br /> E y�J' G � 1 � ADDITIONAL PLAN CMECK <br /> OCCUPANLYIOAD fiP[SPRNKLERSREOD HEiG�rtUMiIDTiON <br /> �` � � OTNER _ <br /> uenwr+wn svnu�niEns �; -rj�j <br /> STAT[BUILDING SMCHARGE <br /> n�mYt:ev ��inr+��nrf�novr.nnr CITY OF EVERETT PuouC WORhs <br /> LOCRL SALES <br /> �,-✓ /1{� TAX CODE IS 3105 rorn� � IC� <br /> _, <br />