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f' f <br /> pE � APPLiCAT10�FOR CONSTRUCTI�;N PERMIT everett <br /> rne e�erqroen TO BE COMPLETED IN INK—PLEASE PRINT � <br /> - CITV OF <br /> ` t everett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT , <br /> 259-8810 <br /> DEMOLITION COMBINl.TION ,�' BUILDING MECHANICAL PLUMBING SIGN <br /> - OWNER AILADDR35 QTV ZIP PNONE <br /> :`� ; ��3 ��i�'�A2� Zsz4 ti1r�IX� sT E,/�wi4 5k��i a����6 <br /> iENRNT �� MAILADDRE55 CITV ZIP PNONE <br /> IV <br />_(..c. 1 ARGMI��SIG�MR��RE55/��/ /�/!I'�� / /J ��`l�C�iCll �V`'C �+oO�7� � / J_/��� <br /> � /7/�,</ 7 <br /> GE LONTRACTOR MA1 ADDRESS Y ZIP PNONE LICENSE I <br /> ' _��wlr/r31Li /�s�/ �u��, -��'j/..�k.r4.�i.rl� 91�377�/3-�s3� kw,uc�o`i�fj� <br /> M GHANICAL CONTRACTOR MRIL AD�RE55 ��—CIN� 21P PNONE LICENSE t <br /> t N� <br /> � PLUMBINGCpNTRACTOR M�ILA�OFE55 CITV ZIP PNON[ UCENSE• <br /> �1�i <br /> %��� <br /> � CLASSOFWORK <br /> � XNEW . � ADDIT!ON , �. ALTERATION . �. REPAIR . � DEMOUTION �..���. WOODSTOVFJFRPLINSERT ��- BWLDINGRELOCATION <br /> ]�ff OU R��.-.� �nn /- C � CTPEPSONANDPNONE 0/�^ J <br /> I C.NJTRACTPRIGEOFN'ORK/� � •�"""-' , "' u� '�u(S �/]/GKC.� /y,�`�SSS <br /> ' �ESCAIBE WOFK AND SOUARE FOOTA E INVOLVED � <br /> � <br /> i � � x �' <br /> � PROPOSEOUS OF�UILOING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �jQ,QJ�Fyt -�U� , �i�L�, APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL OESCRIPTION OF PROPERTY�SNOWN BtLOW OR ATTACH FOUP COPIESI PROVISIONS OF LAWS AND ORDiNANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HEREIN OR � <br /> � �ot BLG:.N __ OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> � ` / AUTHORITV TO VIOLATE OR CANCEL THE PflOVISIONS OF ANY � <br /> • !CJ (lPZ ��C�C US OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> '// / /` A/ '� / '/ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � //�R �EFI. COT / /�' �F�W �Q/� s� A�PPLICATFONISSRMADE ANDPE COMP YH WIT�HKT ER .STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. � <br /> SIGNATUNEOFCONTRACTOROR�UTHORRED4GENT D�TE <br /> �,L'l os '- �- o7�j -oo X� . �/�/) '��`..2� <br /> PRQIECTADDFE55 n --l—T'--� '" � <br /> � AG�J . // /� AP TSCITYBIISMESSUCENSENO.ANOBUSINE55NIME <br /> L-JL Ll/ <br /> PLUMBING dECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF E�UIPMENT FEE � <br /> WATER CLOSET(TOILET) � AIC-0./HNDLG UNITS—H.P. � <br /> —�— <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—d.T.U. M ; <br /> SHO`YER CLOTHES DRYERS � <br /> . dITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DI�'HWASHER RANGE HOOD <br /> � LAUh:7RY TRAY ; WATER HEATER <br /> CLOTH6S WASHER � WOOD STOVE ; <br /> URINAL � METAL FIREPLACE 8 CHIMNEY � i <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; . <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING ; � <br /> ROOF DRAINS—RAWL[ADERS � EXHAUST FAN I <br /> SINK(SERVICE—BAR.ETC.) � i <br /> � <br />� II <br /> i I <br /> i i <br /> SUB TOTAL 5 SUB TOTAL S <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: gy, -� <br /> FRONTSET9AGK REAPSETBhCK SIOESETBn K P�ANGMF�,KNUMBER FEE RECEIPTNO. <br /> 7� ' p' ,p��n-d ' ad�ot� so7o.�-�o s7�9� <br /> use LOT AREA VACFNT SITE FEES VALUATION FEE <br /> �� ���n ~� BUIIDING � � `3S;da <br /> t�'PEOGGONiSALLOWAPIE TYPEOFCONSiACiUFI occur�Nn Nooroµulixcuw�s <br /> caour ,y pLUMBING <br /> X/ <br /> s¢E oF BIDG rvo.oF S7oR�Es [7n5ErnENr MECHANICAL — � <br /> �1� Sf �(u — <br /> OCGl1PANLVL04� FlRESPRNNIERSREOD NEIGHTLIMItATION AD�ITIONALPLANCHECK � � � �� <br /> � � i <br /> �u 2-� C�_. OTHER � <br /> � <br /> REASON ORSPRMKLEfiS <br /> STATE BUILDING SURCHARGE ;SO <br /> INTAKE BV PLFNS APPPOVED BY CITY Of EVEREIT PU(LIC WORKS `�Q �OD <br /> J ; ' LOCALSALES <br /> ��.'N/qt TAX CODE IS 3105 rorn� /7 � A S� <br />