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APPLICATION FOR �flNSTRUCTION PERMIT ��«P« <br />rnae�o��,00� TO BE COMPLETED IN INK—PLEASE PRINT � <br />CITV OF <br />everett <br />BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELEC fRIC IJ ____ _� <br />259•8810 <br />i I DEMOLITION i, COMBINATION i � BUILDING id;MECHANICAL i i PLUMBING I I SIGN <br />nWNER Mr111.A0DfiGSS ---- f.I7V ZIP PIIONH��L� <br />�"�cZl�C�iLI�� �L�___L'{ � � 1,-� �; I f'i � _�.i� �=c, � , :1 `�_� _-���3 / <br />TEN�NT MAII.AI)I1flE5S f.I�Y [II' PIIONE <br />ARCIIITECTORDESIGNER A1RII.A[10R@SS CIIY lIP � PIIONE <br />GENERALCONTRACTOFl MRILADDRE55 CITY ZIP PIIONE LILENSE• <br />MFCII�NICAL CONiRACTOR MFIL AD�fiE55 QTY ZIP PMONE <br />LICENSE � <br />�91RS�1'�11L.70� A��111dnd/ �:/ln lln C: S �° �z. nt_,�„ i.. C• c �: �:� _., n�.._ �._ . . �_ . .�., .. _ .. <br />PLUMBINGCONiP�CTOFl M�ItAO�RESS <br />C1A55 OF WORK/ <br />I I NEW l i ADDITION !; ALTERATION <br />CONTR�CTPFIGEOFWORK � I.JCi <br />� tG�l DESCBIPTION OF PfiOPGBTY �5110WN CEI O' <br />lOT _.... BIIxN OF <br />JK;I� <br />TYPE OF <br />'NA7cR CLOSET � <br />SHOWER <br />KITCHEN <br />JG FOUNTAIN <br />DRAIN <br />P110NE LICENSEr <br />i I REPAIR i! DEMOLITION i I WOODSTOVE/FRPL INSERT I i BWLDING RELOCATION <br />I WNIAGIPEI150NANUPIIOHENO <br />— — — -----'— <br />SINK �SEFiVICE—BAR, ETC.) � <br />----- ---'----__ . <br />-- ------ �-- <br />�- <br />---- � --'-- � <br />--.. .... . . � <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTALFEE S <br />FOR OFFI.;E USE ONLY: <br />FHONTSETBRCN RERRSETDACK SIOESETBACK <br />USEZONE LOTRREA VAfANT517E <br />ivPE 0( f.ONIS �I1 OWApI I <br />SIZE Oi fl1.�G. <br />OCCUPANCYLO�D <br />REASON FOP SI'11INNI ERS <br />INTAME pV <br />IYPE Of CONSf Af.11U1 <br />NO OF SIDfllCS <br />FIRE SPIINKI EI15 BE( <br />PL�NS APPf O�ED OY <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORqECT. ALL <br />PROVISIONS OF I.AWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUiHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTIfER STATE OR LOCAL LAW pEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SIGNAiOREOFCO�TR�CIOROR� H12EDA EN7 OATE <br />X � \ �_�J e\� ',,�_lz - �-l� <br />APPI.ICPNT5 TY pl19aE'S LIGENSE NO AND BUSINE55 N�ME <br />N0. <br />AIR <br />VENTILATION I <br />RANGEHOOD <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN: <br />I1EAT PUMP <br />FAN <br />PIAN <br />OF <br />BUILUING <br />1141i1'AI�Y N�ItlIM1111�S11N115 — <br />GIIIXII� <br />('I.III.IOING <br />- _.._._—..._—'_. "" _".—___ <br />ORSGMENI <br />MLCHANICAL <br />11e1mrt I InuTnil(N� �DUITIONAL PLAN CHECK <br />_ OIIIEH <br />STATE BUILDING Sl1RCHARGE <br />CITY OF EVERETT pl10LIC WORHS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAI <br />EMS—B.T.U. M E.A. <br />S.U. M � <br />--�-- <br />� <br />� <br />—�— <br />� <br />�_ <br />� <br />� <br />8 CHIMNE'+ — � <br />—�— <br />— _ <br />� <br />—'_— <br />� <br />� ' <br />� <br />— ---�— <br />_ .._ _ . . . ... . _....._...�_..— <br />— --i— <br />SUB70TAL $ ;i� �Ut7 <br />PEFMIT $ y ;pp <br />TOTALFEE $ .S�J � <br />fEE RECEIPTNO <br />VALUATION FEE <br />i <br />— , <br />1 <br />� <br />_ _ ---�— <br />. 30 �O v <br />— __.. � <br />i <br />— ' <br />i <br />_ � <br />T <br />1 <br />— _ ; <br />� <br />3C> �on � <br />