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APPLICATION FOR COt�lSTRUGT��.N���"� � ` ` <br /> y^E y. TO BE COMPLETED IN INK—PLEASE PRINT FEB 14 1gg <br /> QTY Of <br /> everett <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ CITY OE���j <br /> � �� BUILDING DEPARTMENT K• ermit Counter <br /> > y 259-8810 <br /> c `� H DEMOLITION COMBINATION BUILDING ECHANICAL PLUMBING SIGN <br /> M41L FDDFE55 GI�Y ZIP PHON=_ <br /> � �v, U'ER �.�lt P. �� � sd' r.ve�et 5fr3oi <br /> yH ros e ��ARApORE55 CITV � 2iP F ONE <br /> � � TENANi <br /> y� �1 <br /> �H � ARG�iTECiOR0E5�GNER MPiLAD�RE55 CIiV � � Z�P PHONE <br /> yy ~�C.�-'1 Roperf �n�neer,r�q I501 1✓��t-1/o�ICv v ��'7 9�0�� $37' 777�6 <br /> �.Z `l. 'a GEN[NAGONTRPLIOR MRIIADDRE55 CIT 2P PNONE LICENSE <br /> tr� H `V' a�G �"� � � P� A)Z� R.Cvtifo✓� 2'17 (lll [� <br /> St �G QNI� GIiY 2P �/ PNO� �y�n/ ���/� <br /> IdcP�ANICALCONTRACTOR IAARADDR[55 pOOI 39S-y�o7 PA"�I�I�/�'TUZ <br /> H � g -„ ro Inc 1702 P�ke St ��W A�R�r ✓� 9 <br /> H• (] QTV ZIP PHONE IIGENSE <br /> PIUM�INGCONiRACTOR M�ILRDDflE55 <br /> z ~�j 5 aff c�naricc <br /> y 2 cussoFvroAK <br /> ~ y NEW �, ADDITION �LTERATION �: REPAIR �. .� DEMOLITION WOODSTOVE�FRPL INSERT �.-. BUILDING RELOCATION <br /> g� <br /> N CONTPCTPERSONANpPHONENO D � <br /> d� 1�5✓��� o�p�'y'0 <br /> 5 CONiRAGTPPC[OFK'OPN <br /> �� �if U6CRIBE WORK AND SOUAR���TAGE iNVOIVED (� �" <br /> �� O�� , v (T 0.�C.r r � 4V�I <br /> y � � I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PnOPOSrED UiE Of DUtLOING <br /> W/LCfC�10JS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRiPT10NOFPNOPCRTYISNOWNBELOWONATIACHFOIIRCOPI[51 PROVISIONS OF LAWS AN�OPDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ipr___ BiaK � NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTiON.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORN FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO"ITRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNATUREOiCONiRALTOPONRUi��ORp[DAGENL DAi[ <br /> --�a� xE���J_��sE���' -re !h <br /> pq�V[GTApU�'['�'�.: pppLICANiSUTVpU5ME55LICENSENOANDOl15ME55N/.AI[ I' IC/l/�J <br /> �l ' J I✓"7V!` <br /> � a Sf <br /> ' 1 PLUMBING MECHANICAL <br /> ryp, TYPE OF FIXTURE OR ITEM <br /> FEE NO. TYPE OF EOUIPMENT FEE <br /> '�I WqTER CLOSET(TOILET) A-C-A HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> ' ' LAVATORY(WASH Bf+SIN) UNIT HEATER$-B.T,U. M �_ <br /> ■/ SHOWER GLOTHESDRYERS <br /> '�• KITCHEN SINK 8 DISP VENTIIATION FAIJ <br /> DISHWASHEP RANGE HUOD <br /> ' LAUNGRV TRAV WATER HEATER <br /> ' CLOTHES WASHER � WOOD STOVE <br /> URIN�L METAL FIREPLACE 8 CHIMNEY <br /> �' DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT r UMP <br /> ' BACKFLOW PREVENTERS � GAS PIPING <br /> FOOFDRAMS-RA�NLF.ApERS E%HAUSTFAN <br /> '�I SINK�SERVICE-BAR.ETC.) <br /> '�' - <br /> I SUD TOTAL 5 SUB TOTAL � �D � <br /> ' PERMIT S � PERMIT 5 � <br /> TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: AEceirr r�o <br /> fRONiS[ipnCK �CGPSET�ACN SiDE SETBPCK <br /> PUN CMECK NUAIBER FEE <br /> USEZONE LOTARE� <br /> VACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> 7VPEOfCONiS.PLLOWRBIE TYPEOFCONSL.PCNAL accqaper x00tpv:uuNcuxnS PWMBING � <br /> SREOFBIOG. NO.OFSiOiilES BASEMENT MECHANICAL �� _ <br /> pGGpPANGYIOAD FIFESPONNLERSREOD HEIGHT�IMIiqTION <br /> ADDITIONAL PLAN CNECK _ <br /> OTNER — <br /> PEASON FOfl SPPINNL[RS <br /> STATE BUIL�ING SURCHARGE <br /> ir�;pKE l3v �PUNSR�'Pno�13Y CITY OF EVERETT PUBLIC WORK$ ' <br /> LOCALSALES f�; � <br /> TAX COUE IS 3105 TOTAL <br />