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f" <br />APPLICATIOI�'��--FOR COPISTRUGT'ils�l PERMIT <br />� E�� TO BE COMPLETED IN INK—PLEASE PRINT <br />CI7V OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 <br />HEATING SYSTEM: U GAS � ELECTRIC ❑ <br />everett <br />e <br />❑ DEMOLITION � COMBINATION � � BUIIDING '' MECHANICAL �[PLUMBING � SIGN <br />OWNER MAILADDRESSf,�V ,EhjAk �/1Lii� CIIV 21P PNONE <br />BoNG1R�0 �utJE 3�felS pAcrF+LHuIT',io. FFqI".�AL(d�q�';�003 8.'�8-�_Kl,� <br />TENANT MAIL�DDRESS CIIV ZIP PMONE <br />IIRLHIiECiORDESMNER MAILAODR[55 CIIY ]IP PIIDNF <br />(�1A) tJ � I� <br />GENERQCON7R�C70R MNLADDRE55 C�IY 21P P110NE LICENSE• <br />MECNANICAI.C(Nl111�C1011 ANIL�DI�Pf55 —"—�IIY ]IP 19M�1lF IICENSF.� <br />. PLUMBMGCONiR�CiOf1 MAl1.�Dl1fif55 CIIY 71P P11r1t1f- LICENSE• <br />i I 1 NEW I I ADDITION �� ALTEfiATION <br />� LOT <br />� PRQIECT <br />f PRICE OF <br />Y/diN �NI <br />! i REPAIR �' DEMOLIfION '� WOOUSTOVE/FRPL INSERT I� BUILDING RELOCATION <br />coNtnc� ren.sor� ne�o ri�or+e r+o <br />t <br />Ln�plo" ` —- �� I HEREBV CLRTIFY THAT I HAVE HEAD AND EXAMINED THIS <br />APPLICATIOIa AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OFPOOPERTY �5/10WNBELOW ORAIt�C11fOUR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WOFiK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />BLOCN or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />_ . APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON7 P.ACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGN�IUREOFCONIMCfO00Rl1U1NOR12EUA6ENT U�fE <br />X �% `.��� � . / / _ �n. <br />UUNDRV TRAY <br />CLOtHES WASHER <br />URINAL <br />DRiNKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />OR ITEM <br />BUSINESS NAME <br />NO. TYPE OF EOUIPMENT <br />— A/C—NHNDLG UNITS—H.P. <br />FORCBD AIR SYS7EMS—B.LU. M <br />— UNIT HEATERS--B.T.U. M <br />SUBTOTAL $ _1'(l� <br />PERMIT $ lU'_ <br />TOiAL FEE $ , :7/J : — <br />FOR OFFICE USE ONLY: <br />FRONTSE78ACK OE�(i5E104CH <br />USEZONE LOIAfEA <br />fYPE01GONI5.ALLOWABIf IYPCOfGON51ACIDAl <br />size oF oioc. <br />O(:CUP�NCYLO�U <br />PEASON FOR SPRINNIEBS <br />■ INT�NE BY <br />rvo. or sromes <br />FI(1B SPI1NNlE�SfIPC <br />PI �NS �PPIIOVf D PY <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />SIpESFip�GN � �L�NGIIECKNUAlI1E0 <br />V4C�N1 SI1G rtts <br />OUIIDING <br />ncar�Hr,r rioromxuixruxns <br />�A��m PLUMUING <br />onSEni[NI MECHANIC�L <br />❑F.it;nlliMilnuON �DD�tIONALPLANCII@CK <br />OIIIER <br />STAIE BUILOING SUIiC1iAf1GF <br />CITY OF EVERETT runuc wonKs <br />LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />PERMIT S /J � � <br />tOTALFEE $ 7/a;�)( <br />RECEIPT NO. <br />VALUATION FEE � <br />i <br />� <br />% � ,_. <br />i <br />2�ni:�� <br />