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��� <br />�� x <br />ayy <br />H�� <br />� H� <br />� rTi 0 <br />� WH <br />� H C7 <br />OH <br />H�S <br />(+] Y �❑❑] <br />rHz <br />HH <br />g�' <br />H <br />O C7 y <br />��� <br />H O fyi� <br />APPLICATIO . FOR CONSTRUCTi.�N PERMI'T e�'1fe1 <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />tne fi e�grc�en <br />CITY OF <br />eve rett HEATING SYSTEM: U GAS ❑ ELECTRIC , <br />BUILDING DEPARTMENT <br />259-6810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />p��yqEq MMLAD�RE55 CrtV p2�� PMONE /] <br />1I_�LAL"✓ �k/j)I.YJ ZC �IO(o G�IqND C% r/�%I �JO ZL I L SZ �%7 S�i <br />1Ery�N1 � MRILADDRE55 GTV :IP PNONE <br />AaCHREGTORDESiGNER MPR�ODRE55 GiV ZIP FMONE <br />. . �vv .. .._ � /I_ . � <br />GN / ' <br />GENERAICOHTRALTOR M�IL�DDRE55 LITV 2iP PnONE U • <br />MELMANICRLCONTR�CTOR MRIL/.DORE55 CITV 21P PHONE LICENSE+ <br />PLUMOMGCONiRACTOR i <br />LUSSOF WO�K <br />� NEW � ADDITION <br />CONTRRCTPRiGEOFWORK �'/ ; <br />DESGRiBE WORK RND SOWP[ f001 <br />,n/>,,� ltoo � csf� <br />PR�jOPOSED USE OF BUILDING <br />.CP.� 'c%O.✓- <br />LE WL DESCRiPT�ON OF PROPERTV <br />LOT OLOCN _ <br />�Qia r/I.Jo <br />1MBING <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />IAVATORY(WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASH <br />URINAI <br />DRINKING FOUN <br />FLOOR DRAIN <br />BACKFLOW PRE <br />ROOF DR�INS— <br />SINK �SERVICE- <br />PpPNE55 <br />FLTERATION �C REPAIR <br />�n o� <br />Cltt 21P <br />DEMOLITION WOODSTOVE/FRPL INSERT <br />CONiACT PERSON AND PNGNE NO <br />/ <br />BUILDING RELOCATION <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND K�lOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OELOW OFATTRCN FOURCOP�ES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PflOV1510NS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TH[ STATE <br />CONTRACTORS LAW 18.27 RCW AND 29620� WAC. <br />S�GNATUR[OFCONtRACTORORAVTNORREDAGENT OATE <br />� l.ln % ,!� r`Y�2L � �Z •�� � C% � <br />pPp��pANLS GTV B1151NE55lICENSE NO MJ� BUSINESS NPME <br />[�]J <br />FOR OFFICE USE ONLY: <br />FRONTSEIBRGN AEARSEi�nCN <br />IVP[ Oi GONIS <br />SRE OF BIOG. <br />INlpk[ OY <br />\OLAq[R <br />0.lOWRBI[ 7YPEOiLON51 ALiURI <br />NO OF STONIES <br />OAD FlR[ SPRNNLElIS R[C <br />SPRiNKLERS <br />PLRNS APPROVLU OY <br />5 <br />N0. TYPE OF Ei <br />N�NHNOLG UNIT£ <br />FORCED AIR S`.'STE� <br />UNIT HEAiERS—B.T.I <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAI FIREPLACE 8 <br />FIREPIACE INSERT <br />HEAT PUMP <br />NUMBER <br />VAC4NTSrtE rcca <br />BUILDING <br />aa��vn uodonnurcv.'s <br />LPp1° PLUMBING <br />ons[MENi MECHANICAL <br />NEIGIITUAIIiRTION AO�ITIONALPIANCHECK <br />GTNER <br />STATE DUILDING SURCHARGE <br />CITY OF EVERETT ruouc woaKs <br />LOCAL SALES <br />Tp)( CODE IS 3105 �oTA� <br />�[.yr:�� <br />1 <br />� <br />