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�"' AIPPLICATIO�. FOR CONSTRUCTI.�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �EmJrcn <br /> ,_.. ----------- �-- ------------- ---�� -----_. .. -- ---� <br /> i HEATING SVSTFM: J GAS J ELECTRIC J____________. <br /> BUILDING DEP�RTMFN�i �- — - _ ---- I <br /> 259-8810 r/ <br /> D[MOLITWN COMBINATION y BUILDING _MECHANICAL PLUMBING SIGN <br /> awNrn --- ue�iwcnrss ti urr " — <br /> I�� P��ONC <br /> 7� QoE�,�y co.��.e. l3�X 37�7 M�5 �h-7c s�r�m�- �-,i/� 9Rr2� 3yz•-sP�Y <br /> y 1rIqN1 /� M�IL�ODRF55 Giv 11 pry�E <br /> p7 P b �� [�OL�/N('1 GO. __ <br /> � y � �R�Nit(C10R�ES�GNEN M11lADDFcSS �?Y <br /> $IP P��E <br /> � 90M C'._ v �.;a.,n.��N /�,.rE.iL.0 (',i ''�C.'_CCK IC1�j, ISSA �Pc�4iY , I�iA�. `,l,T't-c�� '9.., _/:. 7 / <br /> � N GEv!qel LO1ITR�CTOA M�LL�DOBE55 /� GI�Y "� Zi� Pp�qNE ST�TE IICENSE� <br /> � �j 1_J�l�_f..,- °�rl�-�/Li,-�-•.T /Me-Q.'.f... / . �_�Cl� J )�..y ,..�iC�n-4Lf . (�/� `�Oi l.y �fr,-r• L.i.L,fML/[r� VQI <br /> r� n NCCH�NICMCONT11�C10R M�LL�pDRES. piTY ZIP PnpNE Si�TEIICEN5E1 <br /> O W O <br /> "7 N hpi ___ <br /> 1y-�� �•wrAAwGGON1R�GlOi MMLLODRE55 �rtv I�v PqpryE ST�TELICENSC� <br /> � N " CUS50� NOPI. <br /> %� � x NFW � ADDITION ALTERATION REPAIR . DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> My , CONT�ClOER5O4ANDPHONE NO/� �y�,/���i <br /> GrH CONif1ACTPRICEOFWORN �ON•� /f�� �JyT"/'UC�/CS�I <br /> L� D[SCRiBE WOPK�ND SW�AE FOpiRGE iNVOLVCD <br /> M <br /> � y I'r �# �ca:.c �? v <. r 26b -3s63 <br /> C N�+ rnoroseouseaeuaowe i HEREBV CERTIFV THAT I HAVE READ AND ERAMWED THIS <br /> �� �q !�^��T'{ (�Y-i i�. �r- '� — �( � APPLICATION AND KNOW THE SAME TO OE TRUE AND CORRECT. ALL <br /> '� y L6WL�ESfPoPTqNOFPFOPERTY�SNUWNBEIOWORR1��qFO11RCOPiE51 PROVISIONSOFLAWSANDOPDINANCESGOVERNINGTHISTYPEI:�� <br /> WORH WILL BE COMPLETED WIiH WHETHER SPECIFIED HFREIN OR <br /> �o� BLOLK _ OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTMORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STAiE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFUC110N. THAT I AM AUTHOR12ED BV THE <br /> OWNER OF THIS PROPEFTV TO PERfOqM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COIdPLV N9TH THE STATB <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> x ��-*�-��..;/ /. l�^�i� ' y//�/y�,. <br /> vRp1ECt�DONE55 / sma�•irvt p�.� <br /> �3 �N. C/�-Sin/O /2�. y��' � l�� c�..eus.rcss��:rMs��c <br /> PLUMBING MECHANICAL <br /> /��„ NO. TYPE OF fIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET�TOILET) A�C—A'HNDLG UNITS—HP <br /> BATNTUB FORCcDAIRSVS7F.M5—B.T.U. M E.A <br /> � LAVATORV(WASH BASIN� UNIT HEATERS-0 T.U. M <br /> � �_ SHOWER CLOTHESDRVERS <br /> �_ 1 KITCHEN SINK 8 DISP VENTILAiION FAN <br /> � DISMWASHER <br /> RANGEHOOD <br /> LAUNDRVTRAV WATER H[ATER <br /> � CIOTHES WASHER WOODSTOVE <br /> � URINAL <br /> � I ' MEl"AL FIREPLACE 8 CHIMNEV <br /> � � DRINKING FOUN7AM FIREPLACE INSERT <br /> FLOOR DRAIN MEAT PUMP �— <br /> B/+CKFLOW PREVENTERS GAS PIPING <br /> t� ROOF DRAINS—RAINLEADERS E%NAUST FAN <br /> �'� SINN(SERVICE—BAR,ETC.I <br /> J ' 1_1 �_ <br /> __ SUB TOTAL 5 ' SUB TOTAL F <br /> PERMIT § �— PERMIT 5 <br /> TOTALFEE E TOTALFEE E <br /> ��� FOR OFFICE USE ONLY: <br /> FqONTSETB�CK qE�RSETB�GIc Si�ESETB�LM P��NC/NECnNUrMOER �FE R[CFi�1N0 <br /> ' 4 �.] � <br /> USEZONE �oremn vec�r+isrte PEES VALUATION FEE <br /> BUILDING <br /> fYVEOf[ONiS�IIOWABI[ iYP[O�LOH51LCi l rcNaM� FOpurill�ncumb <br /> , � " � l <br /> ��� PLUMBING <br /> SRE O�BLOfi NO OF STORiES � � MECHANIC�L <br /> SYAE� <br /> i3a 5 F� ti.� <br /> OCCUf'ANCVLOAD FIRESPRNKLERSPE00 NEiGNTIiMIT�TI(M� ADDITIONRLPLANCHECK ,� � ` _. <br /> �� SPRINKLEP <br /> f1E�50N iOR SPRINNLERS <br /> r _ --�— <br /> STRTEBWLDINGSURCNARGE �� � 5-�% <br /> INTARE BV PUNS PPRO EY CITY OF EVERETT PU9LIC WORF$ � <br /> LOCAI.SALES <br /> �� TAX CODE IS 3105 rorni \�c' ; ,,, <br />