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r�i r '� <br />�_� r� <br />9H <br />,t� z x <br />9Hc~i� <br />Has <br />yzH <br />.e � <br />r7 xl <br />� H "�jJ <br />F,� y.h <br />`� <br />�HC <br />H�O <br />G� � qC] <br />9 H ti7 <br />r r-i H <br />g� <br />N <br />fC'], Ci m <br />Cj1 � Ci7 <br />x.�m <br />H O Co <br />APPLICATIO►. FOR CONSTRUCTI�P! PEFtMIT �'��''�'" <br />;. �.,,. .,,,, TO BE COMPLETED IN I�K—PLEASE PRINT � <br />atr�r <br />everett I HEATINGSYSTEM: ;]GAS �IELECTRIC J_ ___ ___=J <br />BUILDING D[PARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUM�ING SIGN <br />�..'.: H MAiL ADORE55 UiY ZIP PHONE <br />�� ��:.T �x.( lnrk l�c,y3-� ' l)_ L�. -It 1`?Zii C-i=�-GL"La <br />�,,,erli 6�AiLApDHFSS Utv i.�P PIIONE <br />.��:.��mECTORCE5IGNEP IAA�LADDRE55 CITV 2iP PMUNE <br />�;,�1 �_ r, <br />il:CftnICONTf1AGTOR, AUILApDRE55 CiTV 11P PHpNE LICENSEs <br />� �_I E <br />..:c��ntl�CqLGONiRRGTOF MRilp0�RE5S dTV ZiP PHONE UCENSE/ <br />�;C!�OiNGCONTRACTOR MNLAp�PESS <br />;:i z550F WORK <br />NEW � ADDITION X ALTE(iATION x REPAIR <br />__' . / �'OO� <br />cOYI RACT PR�CE OF WORY. <br />�D-i.{y�CPipEWOR{K�N�50/U�ARFFOOTAGE�'ivO�VEO 1������Cr_. `..-� <br />l_IC1�V�L('�C � � l��'�Ci:1'�-Irv� 1�fCt-��\' 1(f \� <br />e <br />i'I ,�rOS[0 USE OF pUROiNG <br />CITV 21P F��ONE LICENSE • <br />DEMOLITION WOODSTOVEiFRPL INSERT <br />ICOYiACT PERSpN ANp PHONE N J <br />��.��.1. l'�-...�� ' � <br />c.L�LsT <br />�' ��'� .t OESCRIPiiON OF PROPERTY �SNOWN 9ElOW OR ATTACH �OUq COF�ES� <br />io,__S+C+�zZ`ie�ocn �-1`io oF Cucc� _ <br />V � i ��, f ni��� C?z,., 3� <br />C <br />. --; nco���s; — <br />"ll(� Me]�ouCq�L <br />PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />� WAT[R CLCSET 1T04F7i _ _ _ <br />LAVATOPY�WA <br />SHOWER <br />KITCHEN SINK <br />DISHWASliER <br />CLOTHES WASHER <br />URINAL <br />BACKFLOW PREVENTERS <br />POOF DRAINS—RAINLEADERS <br />SINK �SERVICE—BAR, ETC � <br />SUO TOTAL S <br />PERMIT 5 <br />TOTAIFEE 5 <br />' FOR OFFICE USE ONLY: <br />�HO�lISHO�CN RURSEiOACN <br />�f �UI <br />iL! hb�1 iOtAnrn <br />R-Z � So�� <br />���:nILONISAll01YA81E �YPF�fLOqcldCl�b:l <br />T%_�1 'R . <br />�.i o� <br />7L <br />ISwY <br />�: <br />iR.i.��yeatnae� <br />FlPE <br />i�o <br />SIUE 5[1�4[K <br />S� <br />V4CAHi5rtL <br />Ao <br />�]Cmntk[i . al�'.•,. , <br />�3 - <br />O�SCMENL <br />L <br />e.rn..� ��� rinNsnrrnovt.uov CITY OF EVERETT <br />9� LOCAL SALES <br />��/ty TAX CODE IS 3105 <br />BUILDING RELOCATION <br />I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. �LL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />V/ORK WIL� BE COMPLETED WITH WHETHER SPECIFIED F!ER=1N OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORIiV TO VIOLATE OFi CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEPFOR6fANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 7HIS PROPERTY TO PER�ORM THE WOFK FOR \VHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS lAW 182� RCIV AN�J 2962001VAC <br />SioN>tUREOfCOy1RAC1CHCIi4lI1r.,Yt,�iJdGf'J Fdlt <br />X � \-, <br />�--:��.�r i -,,,. <br />- - - - --- <br />,. . ���,. . �, �,���:,:� � ._�._� :., � � :.•:���, . _ <br />NO. TYPE OF EOUIPMENT <br />A C—A HNDLG UNITS --HP <br />FORCED AIR SYSTEMS—BSL. M <br />UNIT HEAT[RS—B.T.U. M <br />CLOTHESDRYERS <br />RANGE <br />WOOD STOV[ <br />h9ETAL FIREPLACE 8 CHIMNEV <br />FIREPLAC[ INSERT <br />HEAT PUI.1P <br />[XHAUSTFAN <br />nw�oiNc _ __ <br />PLUI.IBING <br />Id[CNqNICAL <br />ADDITIONAL PLAN CHECK�c <br />OTHER <br />STATE BUILDING SUFCHARGE <br />ruouc woaKs <br />TOTAL <br />SUB TOTAL 5 <br />PERh11T S <br />TOTALFEE 5 <br />/7:t, j f <br />/ij =3- i�rc[ir�rr�o <br />�"=,-, - vis�c <br />