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I <br /> APPLICATIG.� FOR CONST�'iUC7 .JN PERMIT ''`"'«'�' <br /> ih�E�o�9���e� TO BE COMPLETED IN INK—PLSASE PRINT � <br /> CITV OF <br /> � �� everett I HEATING SYSTEM: U GAS U ELECTflIC U __J <br /> 9 H BUILDING DEPARTMENT — <br /> �y �� � 259-8810 <br /> t" � DEMOLITION COMBINATION BUILDING MECHANICAL �PLUMBI��' _ 3N <br /> H •�' o�vryEti cirv z r aHor+E <br /> M4iL AODPE55 <br /> � � �� S K�/�E.' nii� C� -i,�Tc�7`; �`E�— <br /> H _ -- <br /> O x O r�r�nr�T r.k nooaess � . �Y� NE .�"1f�9 PHONE <br /> �q y.,d //Y3.y- .�G � �' 7 p� 7o G S3'sv 7/ <br /> � <br /> y � �RCHILECTOROESIGNER MRILA�fJRE55 GITY" 4 2iP P ONE <br /> � y d�y GCNERAICONTRRCTOR MRILA�OflE55 CITV ZIP PHONE IICENSE� <br /> � � `" CItY ZiP PNONE LiGENSE• <br /> 4']� (qq"] AIECHANICALGONTRACTOR MFILAOORESS <br /> 2H3 <br /> ,�y y Z Pll1MBiNGCONTRACTOR M�iLApDRE55 CITV ZIP PNONL LICENSE� <br /> yy sY S V�'l�wih; �� • ��v5�oo�� sC�l ED/1�.�.Uns �iea2� �7G-H3o� SSrLva�o �d <br /> cuss ov wonK <br /> n[y �( NEW ADDITION -. ALTERATION � REPAIR . DEMOLITION � WOODSTOVEIFRPL INSERT �. -. BUILDING REIOCATION <br /> � y CONiAGT PEPSON AND PMONE NO <br /> [iJ <br /> F] �/1 CONiRACTPRiCEOFWOPN <br /> H O VJ pE3CRIB[1YOBNANDSOU4R[FOOTAGEINVOtVED <br /> Pf v_vK b�n <br /> PiIOPOSEUUSEOFBI. OiNG I HEAEBY CERTIFY THAT I HAVE READ AND EX�MINED THIS <br /> N�-� `�� P�—J APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE:,T.ALL <br /> -��— PROVISIONS OF LAWS AND ORDINANCES GOVERNWG THIS TYPE OF <br /> LEG4l0E5CRIPT10N0iPPOPEFiVISNOWNOEIOWORATfpGHFOURLOPiE51 yypRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or oiocK oF NOT. THE GRANTING OF A PERMIT DOES NO? PR[SUME 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 AIA AUTHORIZEO BY THE <br /> OWNER OF THIS PROPER?Y TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 29G.200 WAC. <br /> SIGNATIIREOFCONiRAGTORORAOT��ORI2E�RG[NT DAiE <br /> X �.,.u,�2�. ����� �i�b/Y/ <br /> '_' PROJECTAODRE55 _ APPIC4NTSCiTY8i5WES5LiCENSENOANDOIISiNE55NAME <br /> '7 O8 � C 1/ <br /> � ' PLUMBING MECHANICAL <br /> � NO. TVPE OF FI%TURE OR ITEM FEE :�0. TYPE OF EOUIPMENT FEE <br /> f�' WATER CLO�ET(TOILET) p �= A-C-lvHNDLG UNITS-H.P. <br /> BATHTUB FORCF.D AIR S`.'STEAIS-B.T.U. M E.A. <br /> LAVATORY(WASH�_ASIN� O � UNITHEAT�i1S-B.T.U. A1 <br /> '�� SHOWER CLOTHES DRYERS <br /> ' NITCHEN SINK 8 DISP = � VENTILATION FAN �_ <br /> �ISNWASHER •�. � RANGE HOOD <br /> f _ LAUNDRV TRAY WATER HEATER L <br /> CLOTNES WASIIER - WOOD STOVE <br /> �' URINAL � METAL PIREPLACE 8 CHIMNEY <br /> � DRINKING FOUNTAIN � FIREPLAGE INSERT <br /> ' FLOOR DFAIN 5�' - HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING _ <br /> � ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> '�' SINK(SERVICE-BAR,ETC.) <br /> � <br /> � ' SUBTOTAL 5 _/ ' .f� - SUBTOTAL $ `J' 'S� <br /> PERMIT S PERMIT S � <br /> TOTAL FEE 5 :?�" ' TOTAL FEE 5 '.S D <br /> FOR OFFICE USE ONLY: <br /> FRONLSEtt3ACK f1E�H5EICACK SIOESETB/CK PIANCMECRNUh10[R F[E RECEIPTNC <br /> usezor+e LOTRflER VACANTSItE FEES VALUATION FEE <br /> BUILDING <br /> ttiEOitONiSPIlOWABIE iYGEO(LONSTAGNAI MGq�pp boawi¢uucc.:rs ' <br /> PLUAI�ING �3 s/�T_ <br /> 5iZE0FBtDG. NO.ocSTOeiES 6�5[MENi MECHANICAL 35` iS� <br /> OCCUPANGYl0�0 flPESPRNNlE05REOD MEIGNTLiMITP➢ON ADDITIONALPIANCHECH <br /> OTNER <br /> ——T <br /> R[PSONi0R5PRiNNLERS <br /> STATE� �ING SURCNARGE <br /> iNipKEBV �LRNSRPPIIOVE��Y CITYOFEVERETT PIIBLI:WORK$ <br /> LOCAL SALES �� � <br /> TAR COOE IS 3105 TOTAL /�c � ; ;-" <br />