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� <br /> APPLICATIO.. FOR CONSTRUCTI.�N PERMIT �`'"P" <br /> rnee�P�q�ee� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> y citv or <br /> 5� � everett HEATING SYSTEM� ❑GAS ❑ELECiRIC U_ � <br /> r'� BUILDING DEPARTMENT <br /> Q M ` 259-8810 <br /> �y y DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> MA1 DDRE55 CIiY 21P PNOHF <br /> � �C �w�EA�'o�� � �aLLA �I An� ,�vEeETT' 282a r 252 - o�f 88 <br /> y� IENnNT MAIIRDDRE55 CIiY ZIP PHONE <br /> �d N� 3���[> f;a,�e,g <br /> y AqCHRECTOR�E5IGNER MAi�A0DRE55 CITY ZIP FHONE <br /> � �'] C GEKEPRICONTPRGTOR N.AILADDRE55 GTV ZiP PNONE UCENSE• <br /> � f"1 �y <br /> � � `� hIECHANIGAL LONTRRGiOF MRIL ADDRESS CITV ZIP VHONC �IGCNSE� <br /> �r n <br /> �"� <br /> 'y PIUMBINGGONiRACIOF M4ILRDORE55 LITV IIP PNONE LIfFNSE• <br /> E� <br /> �"� <br /> ��A C1P550F WO11N <br /> n�y NEW �. ADDITION � ALTERATION REPAIR '�DEMOLITION WOODSTOVEFRPL INSEHT - L•UILDING RELOCATION <br /> � CONTRCT PEFSON AND PNONE NO <br /> f,ONTP�CT PRiCE OF WORK <br /> �Q y pc5Gq1��pf1_WOANPND(/�QUAREFOOTPGE�NVOLVED <br /> 11� IN-c7C<� — <br /> vaoaoseousEOFaw�owc I HEREBV CERTIfY THAT I HAVE READ AND EXAMINED THIS <br /> S�2 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL OESCR6'O N OF PROPERTV ISHOWNBELOW OR RTIACH fOURCOPIE51 PROVISIONS OP LAWS AND OFDINANCES GOVERNING THIS NPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior�_ e�aK �� oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR GANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR IOGAL 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 THE STATE <br /> - CONTRACTORS LAW 18.27 RCW AND 296.200.NAC. <br /> SiGNAtUREOFGONTNRCTORORNUTHOR�ZEDRGENi �ATE <br /> _3 2 13 A^'� 3 21 I � �., v� X��y1d-�L,� �.�-��✓ /�/3��/ <br /> � FRQIECiADDRE55 pp �i�pryiSCITYBU51NE55UCEN5ENOPND�t15wES5NPME <br /> '�1 �t�� <br /> ' PLUMBING MECHANICAL <br /> I� NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WA�ER CLOSET(TOILET) NC—NHdDLG UNITS—H.P. <br /> '�1 BATHTUB FORCED AIR 5`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B T.U. M <br /> 1�I SHOWER CLOTHES ORYEFiS <br /> NITCHEN SINK fi DISP VENTILATION FAN <br /> 1 DISH\NASHEH __ RANGE HOOU <br /> ' LAUNDRY TRAY WATER HEATER <br /> CLOTHGS WASHER WOODSTOVE <br /> URINAL h1ETAL FIREPLACE 8 CHIMNEY --I— <br /> '� i <br /> DRINKING FOUNTAI�' FIREPLACE INSERT �_ <br /> 1�' HEAT PUMP <br /> FLOOR DRAIN <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> �' ROOF DRAINS—RAINIEADERS EXHAUST FAN <br /> � SINK�SERVICE—BAR,ETC.) <br /> �1 <br /> —1 � <br /> SUBTOTAL $ SUB TOTAL $ <br /> t� PERMIT $ --T P[RMIT 5 . <br /> �- - TOTALFEF S TOTALPEE 5 --� <br /> FOR OFFICE USE ONLY: <br /> PIANCN[C�NUMpGR FE[ RECEIPT110 <br /> fPOM SETBACh RERRSETBACN SIG[SELOACK ' <br /> usczor+e �otaaen vnen�+rsnc FEES VALUATION FEE <br /> BUILDING <br /> hPEUfLON�5AlL0'NqBlt iv�EOfGCY5iRL1URL aaq��va xoa�ov.'R�wcuxas - <br /> PLUMBING <br /> SREOFBLOG NO.OFSTORiES OASEMENT MEGHANICAL <br /> OGLUPANCYLOAp FlRESPRNNtERSREQ� MEIGHTLIMITATION <br /> ADDITIONAL PLAN CHECK <br /> OTHER <br /> �� <br /> Rf.A50N FOR SPRINNI[RS <br /> STATE OUILOING SURCHARGE <br /> winneov ru•r+sneanoveoov CITYOFEVERETT rUeuewoaKs <br /> LOCAL SALES <br /> TAX COOEIS 3105 TOTAL <br />