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yry i <br /> - � APPLICATION FOR CONSTRUCTi.iN PERMIT �����" �; - <br /> � e' fheEvergreen TO BE COMPLETED IN INK—PLEASE PRINT , <br /> CITY OF <br /> everett HEATINGSYSTEM: ❑GAS �ELECTRIC ❑ — <br /> BUILDING DEPARTMENT • <br /> 259-8810 <br /> DEMOLITION COM9INATION BUILDING �(MECHANICAL : ' PLUMBING SIGN <br /> � OLYNER MAiLADDFE55 CIiY ZIP PHONE '� <br /> G.`��lxR 5�vp, �v�e�zccn, t,u..� �v.�ti� a8�o9 �s9-s3co <br /> IENANT I.IMLA�� E�5 CITY 21P PMONE <br /> �n,rw�s�,��.Z�n�• �iz:��mc �2c� S.w 1�1F: .`�t��t�� �.v� GF.ibl- 243-�733 _ <br /> �RCHRECTOR�ESIGNER MA�LAOORF,dS CITV ZiP PHONE <br /> ��q � MAILAOOfiESS CITV ZiP PHONE LICEfISEa • <br /> �r� ^C��, tol S.w. !'7g Stnl�lt �✓w 9816� Zt13-b733 <br /> � MELNANICALLONTRACiOP AIAILA�ORE55 CILY IIP FMONB UGENSE� <br /> ro�H 'hollni�� �o�o �u�� A�.1 W. SEnt11c �a,`�� �ti��R 2f33-2s� Ko(I^�� LyIG� <br /> ay�n P�UTABINGCONiRAGiOfi M��LAODPE55 CITV ZIP PH01lE L'CENSE� , <br /> H x�� C,a��wc� m«�, 5�135 G�w✓� 'M�Q v,llc ��z- ��I Cs1��:r�� isig�.,� <br /> H z H LLASS OF WORK _ <br /> �G F3� <br /> �� } NEW �ADDITION � � ALTERATION � REPAIR ��' DEMOLITION . WOODSTOVE/FRPL INSERT .-. BUILDING RELOCATiON <br /> CONiACT PERSON AHO PHONE NO. <br /> � y H LONiRALT PFiGE OF WOFK� 3 yU�n�� '* H o�A•�oVfN <br /> ..y. z� DESC`fl�OE WORK AND SOUAPE FOOtpGE INVOLV i � �. -- <br /> P] y� T,-�i`�.�� uvcNl�ot�a+��i vc�� R+`vi�v f�i�n s�Slt�"� <br /> O H raoaosEous�aFow�oinc I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> 'l� m�1 •��Z i� Z`�^`\ APPLICATION AND KNOW THE SAME TO BE 7RUE AND CORRECT.ALL <br /> �� PROVISIONS OF LAWS AND ORDINANCES GOVEfiNING THIS TVPE OF <br /> 4�� � LEG4L�[SCRIPTI OFPROPERTYISHOWNBELOWOflATfACHF011RCOPIES� yyORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIM OR <br /> x H �ar S BLOLK oF NOT. THE GRANTIr�G OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � y AUTHORITV TO 'JiOLATE OR CANCEL THE PflOVI510NS CF ANY <br /> H y OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR?HE <br /> C7 V1 H PERFORrv1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> n d N OWNtR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �" ❑ APPLICATION IS MADE AND I COh1PLY WITH THE S'i4TE <br /> 3� C+1 t'� � CONTRACIORS LAW t .27 RCW AND 296.200 WAC. <br /> Zy y IGNqiDREOFCONTRALTOR RAUiHOR2EDAGENT DATE <br /> � 0� <br /> � ' <br /> S )vg "L �Vc2"�4EN WA �vLec� ���.y �tiz� \�r.tiF <br /> PRQIECTAOORE55 <br /> APPLICANi CITY BUSINE55 LI E NO.AND BUSINESS NAME <br /> PLUMBING MECHANIC <br /> �/ NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE — _ <br /> '�,� WATER CLOSET(TOILET) A/CrNHNDLG UNITS—H.P. <br /> �_� BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) 11NIT HEATERS—B.T.U. M <br /> '�, SHOWER CLOTHESDRVERS . <br /> `e� — VENTILATION FAN <br /> KITCHEN SINK 8 DISP <br /> �"' DISHWASHEF RANGE HOOD <br /> ' LAUNDRY TRAY i WATER HEATER <br /> ..�� �' CLOTHES WASHER i WOOD STOVE � <br /> �I UFINAL METAL FIflEPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT � � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS I GAS PIPING <br /> i' fi00F DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR.ETCJ 1 L vtrv . iR Vi � <br /> 'v� <br /> i <br /> i' <br /> � SUBTOTAL S ' SUBTOTAI S 'G- <br /> !' ! PERMIT S PERMIT S � �lJ <br /> TOTALFEE 5 TOTALFEE 5 <br /> . � FOR OFFICE USE ONLY: <br /> fRONT5ET0ACN �E4RSETOACK SIDESET�AGK PIANCHEGNNIIRIdER FEE FECEIPTNO. <br /> usezorie toranen VACANTSITE FEES VALUATION FEE <br /> 6UIL�ING <br /> tVPEOiCONtSFtLLOWRBIE t�PEOFCONSiACiOAI C:cu�e!,:r �.00�o.+[w!:6ux�.t5 i <br /> .yT_ I �"I� 7"i _ I.�-�� .`o�''j iy PLUh101NG � <br /> �l'. JL �/ {� �/�J� <br /> S:2ECF0LDG NO.OFSiORiES BASEAIENi� MECHANICAL 7 �_ �/�/'/J(.l <br /> N <br /> lO� L� I•'- � p��ITIONALPLANCHECK � <br /> OGCIIpA�NLYIOAD FiqESPPNNI[RSRE�'D HEIGHTIIUitATiOt! I <br /> / e i.� <br /> �w OTHER <br /> _�-� <br /> Rf.A50NFO115PfliNKLEFS i � <br /> STATE BUILDING SURCHARGE 'i <br /> i <br /> minreuv rinNsnarnoveDor CITYOFEVEHETT PuouCwORKS I I <br /> LOCALSALES <br /> �Z/9 � ,J TAR CO�E IS 3105 TOTA� /�G'd <br />