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M <br /> ln' <br /> N <br /> , �..�4 . . .I <br /> � APPLICATION FOR CONSTRUCTIa�N PERMI'�' r <br /> everett <br /> fho E�vgmen � <br /> CITY OP <br /> everett <br /> BUII_DING DEPARTMENT <br /> 259�8810 TO BE COMPLETED IN INK—PLEASE PRINT <br /> bEMOLITION -' COMBINATION J�BUILDING i : MECHANICAL PLUMBING ' SIGN « � <br /> 01VN R MhILAD�RESS LITV 21P PHONE � <br /> l.'�G1�'i� AICS ///�: E,�fa.,c��.d� ��zu/�� Cl��-�r �i'1�2b/ ?5�3-27a0 <br /> TEN4Nt �IAiLA00RE55 Cltt ZIP PNONE <br /> APCNITECTOROESiGNER MAILRDDRESS CITV ZIP PNONE <br /> � CENEPR�CONTP�CTOR MRILA�DRE55 ITY Z�P PNONE LIGENSE• <br /> H <br /> m�x .���Sr�..t�clzsC�tiS:�y�'S 2y�Sr.r/l L1,P� ��2Z3 �saa��3 .r3.�s��c� <br /> 4' N MECNANICRLGONTRACTOR MAILADDRE55 LiTY ZIP PHONE LICENFE/ <br /> ay�n <br /> r <br /> y3 PLUMBiNGCONTCdCTOR MAILAppRCiS GITY Z�P PHONE LIGENSE� <br /> K n <br /> y^� CLASS OF WORN <br /> o xo _ <br /> 'C y H �NEW , . ADDITION . ALTERATION .�. REPAIR OEMOLITION . ' WOODSTOVE�FRPL INSERT L 1 BUILDING RELOCATION <br /> � O s� CON PhCiPRICEOFWOPNNTERI��qIZOO� CD�JtA�SON�'��OS ���_�I�� <br /> �� <br /> HC OES RIBEIYOFKANDSOUpAEFOOtAGEINVOLVEO� <br /> z �g �-� O &' � <br /> �� � FROFOSEDUSEOFDUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> zy G ����.�' APPLICATION AND KNOW THF SAME TO BE TRUE AND CORRECT.AlL <br /> a q LEGALOESCRIPiiONOFPPOPERiV�SNOWNBCLOWOPRTTRC4FOJRCOPiES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> t.i WORK WILI BE COMPLET[D WITH WHETHER SPECIFIED HEREIN OR <br /> H y ior e�ocK cr NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> bOy �7 e1'/-� , AUTHORITY TO VIOLATE OR CANCE! THE PROVISIONS OF ANY <br /> qO Cq7 f/) t�iY,YJ� // 3>S I L� �� � I '(�.�.� pERFORMANCEOOF OONS RUCTION.THAT I AM AUTHORIZOED BY THE <br /> 3 L*1 t" �� }� � � — OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> [�7 C'1 (/�CJ 1 <br /> x y y APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> y O V1 i�� CONTRACTORS LAW 18.2i FlCW AND 296200 WAC. /_ _�G <br /> �� . 1 �� 5'GNAiURECFCUIRPAC�ORORAUTN'JRRE�AGENT ORTE �p I/ � <br /> 4J l/ <br /> X Q #/7S/� <br /> PaaecrnooaEss /�/1. G!� .�•ClS7G�G� b�e�G'.f4ZT <br /> D^ � �A� '/� / � �oIYEANt5G1V0U5ML55lICCNSENO ANOOt151NE55N�ME <br /> / /�//7 /Y <br /> PLUMBING MECHA111CAL . <br /> �� NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> '�� WATERCLOSET(TOILET� A�C—A�HNDLGUNITS—H.P. <br /> BATH7U8 FORCED AIR SYSTEMS—B.T.U. h7 E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> �T <br /> ���' CLOTHES DRYEFS <br /> SHOWER <br /> i! KITCHEN SINK 8 DISP VENTILATION FAN <br /> OISHWASHER --T— RANGE HOOD <br /> I�UNDRY TRAY WATER HEATER <br /> �� CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNiAIN FIREPLACE INSERT <br /> ' 1'' FLOOR DRAIN _ HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINIEADEF7S EXHAUST FAN <br /> +� .s SINK(SERVICE—BAR,ETC.) ' <br /> �� i <br /> !'� SUBTOTAL 5 SUBTOTAL 5 <br /> PERMIT S �— PERMIT 5 <br /> TOT�LFEE $ TOTALFEE 5 <br /> � fRONi'tiK REARSETBALK SIDESETpACN � 1 PIANCHF NNUM�[R FEE 5.a6S �E�EiPTN�. � <br /> �. '�2�' S '�� � —� C1 <br /> ❑sezorve � LOTMEA VACANTSItE FEES VALUATION FEE <br /> r� y�� ¢ I.i VES '.--. NO gWLOING � 99 � l J <br /> tYPFOFLGNStAILOWABIE iYPEOFtONStACNRI WNreq[r xuo��ux�utin5 — <br /> '�f � <br /> �p�� PLUMBING <br /> 52Eoco�oc. MOAF5i0nieS enSEUGNT MFCHANICAL <br /> S.F � '�. YES X NO � <br /> OCGUPA CYIOAD FlRESPRNNLERSPEO'D NEIGMtLIIAITAIION uTHER � / � : <br /> ' 1 YES LI NO I S r STAT[8 LOING SURCHARGE L �-� <br /> REASON FOR SPRINNI EFS <br /> STq1EENERGVSURCNAqGE � <br /> njlylClJ�BIInCC.OV PlANSAPPqOVEOBV CiTY OF EVERETT PUBUC WORKS �i <br /> �1�1'{zn�f �(',,� LOCAL SALES <br /> / TAX COOE IS 3105 TOTAL ���� <br />