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. [- Zz�l`•-" <br /> ,; ' ` � APPI.ICATION FOR CONSTR/SIC�►.IN PERMIT �� <br /> ?p gE COMP�ETED IN BLACK INK— CEASE PRINT ��T <br /> HEATING SYSTEIvt: J AS �I ELECT � J <br /> y � H BUILDING DEPARTMENT <br /> �� '�J 259-8810 <br /> � i-3 DEMOLITION COMBINATION BUILDING MECHAPlICAL PLUMBING SIGN <br /> [ H ' OIYNER / 1.1PRAOORESS IlY ZIP PHONE <br /> �'� v' -!� • i�f%? � n �- - �F:;: ��-;�'�' ,s - .i4 '�'�'r-�p?;j�n <br /> y�H TENANi /.^ IAAiIADDRE55 �i1V IP PMONE <br /> Ky� ✓, 1'L�C <br /> O r� O A�LHRECtORDESIGNER RIAILADDRE55 GiY ZiP PMONE <br /> � �"I � <br /> fn H <br /> �z � GENERALCOMpNCTOR A'41LA�DRE55 GITY ZI^ PfWNE SiATEIICENSE� <br /> �'] C MECHAWCALGONTR OR hl/ILADDRCSS CrtV D� �HON[ STAiELICENSEa <br /> �� g "T��'ha�.a� �rtxJ; 19��t/�x.191�'.sr. � � /A. 9t�i%,'�f'(�z��``2,� 771�^�,�,%��IO- 'i �=� <br /> � PLUAIBMGLONTRACTOR MAILADDflE55 QiV � PNONE STATEIIC[NSE�� • <br /> zy� C1A55 OF 1YORN <br /> �,,,� y NEW . ADDITIOIJ AL ERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BWLDING REIOCATION <br /> �J�A / M7 CONiACT PERSON�ND PNONE NO. � <br /> � H /� 1J 1/-�.�-4�� . <br /> O G� CONiFACT PFILE OF WOFK (J�`.�� � _ <br /> �� D�SCR�BE VOR NO AR�t AGE iNPOIVf � � <br /> y � l„`',_ ar�n.��a��1as.- ,�11�r rz� , '�� �'w: �'� .�—C�58 ��� <br /> y p y PnoaoseousEOFem�owc i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��-� APPLICAIION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> ieonioescnivrioNOFaaovenrv�sHowNOE�owoanTrncNFouacoPiesi PFOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK�VILL BE COMPLETEC WITH WHETHER SPECIRED HERF.IN OR <br /> �or e�ocK oF NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �����_.--�� ^/��� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AIJV <br /> _,L���-U OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERiY TO PEAFORM THE IVORK FOR WHICH <br /> APPLICATION IS IdADE AND I COMPLV WITH THE STATE <br /> CONTFACTORS LAW 1:�.27 RCW AND 296,200 WAC. <br /> X �/ r�r_� 'c� �-�y- 9�. <br /> IPgJ[GTAU'�PESS � ".•'�.���. � ���[ <br /> s� /�f�yd � �/�� � <br /> i � <br /> /-/� '^/`LC-�`! �' IC�E:! � I�l`! annn. �.s��,ia,:�r — — <br /> '�1 PLUMBING ' MECHANICAL <br /> �O. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEt <br /> 1 ' WATER CLOSET�TOILET� � A C—A HNG'_G l NITS—H P <br /> � BATHTUB ' FORCEfi AIR S��TEMS—�.i.U. Ai E.A. <br /> '�1 LAVAiORVIW�SHBASIN) � UNIiHE^.TcRS-8.7.;;. M <br /> SHOWER CLOTHES DRVEPo <br /> 1 f KITCHEN SINK 8 DISP _ VENTILATIG4 P;�N ' <br /> � DISHWASHER RANGE HOOD __ —T <br /> 1 LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> ' URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPIACE INSERT <br /> ;;� FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ."ri�f 5.�• <br /> � ROOFORAINS—RAINLEAOERS � EXHAUSI .�AN <br /> SINK(SERVICE—BAH.ETC.) i �/C�. � /�%L �Tcs. _ <br /> , __ <br /> � — —_ �— <br /> ' SUB TOTAI 5 SUO TOTAL 5 ,� ; _ <br /> ' PERMIT 5 PERMIT S � <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB4CK REFRSEi�ACK SIDES[TBACN �'LANCHLCrcNNda[N fE[ RLC[IPiNO <br /> 3 7� <br /> usezoue LOiAREA vacaNrsire FEES VALUATION FEE <br /> BUILDING <br /> iVPEOFCONiS.PLIOWneIE ixvEOiLONSt.AClunl IXtuvr,un rvobow[wmcuwts - <br /> csouo � p�UMBIN3 <br /> SREOF9lDG. NO.OFSI0RIE5 BASEMENT �,�ECHANICAL y� <br /> OGGUPANCVLOAD FIRESPFdKLCti5RE0'D HEIGMTLIMI�ATIJN A�DITIONALPLANCHECN <br /> SPRINKLEfl <br /> RERSON FOR SPRINrcLERS --� <br /> STATE BUILDING SURCHA(�GF <br /> MinKC[Jv P�nNSr1PPROVEDBV CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> TAX COOE IS 3105 TOTAL �� i" <br />