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_ ! <br /> ; <br /> ,...� <br /> , ppPLICATIOrI FOR CONSTRUCTr�. N PERMIT everett � ` <br /> e � <br /> ineEreryre�n TO BE COMPLETED IIJ INK—PLEASE PRINT I <br /> CC�� CITY OF � <br /> , ��� ever 2tt HEATING SYSTEM: GAS ❑ELECTRIC ❑ -� 6 <br /> BUILDINI; DEPARTMENT � <br /> 1� � 25��8810 � <br /> � y� DEMOLITION �COMBINATION �I�BUILDING MECHANICAL !PLUMBING SIGN � <br /> M�� OWNER MAIL A�DPE55 � GRY 21P PNONE <br /> ��o f�c� .�moC.. ��.� �` yozn .�v��n S/eE_ J'.�'�'��� cd� f�z�z. (�)S.�y-Udyy <br /> '� iEN�NT MAIL ADORESS CITV � 2�P � PHONE <br /> ��� � <br /> � ~ �FCHrtECTORDESIGNEP IAAh4ppR[55 Grv ZIP GNONE I <br /> ��4� 1�D�S/Y!'/i e l�L4>7nins �ir,f'l4!» /.r�9 �Z2-I"7d y � <br /> �9G GENEPALCONTNAGTOR M�ILAODRE55 Cirv IIP PNONC UCENSE <br /> ��g - �,T-�vi�t�ir� ..:T-�x-l��s. __ �f�nx,a azd���e) 7�Un� �i09�Ti9 ! <br /> E 'H�NICAL LONTN�CTOR MRtL AD�RESS LIiY 2'P P��ONE UGENSE• � <br /> pr (] <br /> H CITY ZIV PHONE LIGENSE• <br /> s PLUMdMGCONTRRCTOR MAiLADORE55 I <br /> r�-+ H _ � <br /> tJ� f.lA$$C(WORK ._ . � . <br /> d �,�p � NEW . ADDITION -� ALTERATION IJ REPAIR .� DEMOLITION WOODSTOVFJFRPLI4SERT . BUILOWGRELOCATION <br /> ��.y CONTACTPEHSONANDPHONENO ' i <br /> �[� VJ �� � � <br /> GONTHACT PNiCF.OF WORN ' I <br /> y Q� OESCRIPE WORN�NO SOU�RE FOOT�GE INVOLVE� <br /> /�5 ,��i i� or"f/CC _ 353- ��112_ , <br /> PNOPO E�USEOFBUILOING I HEF7EBY CERTiFV 7HA7 I HAVE READ AND E%AMINED THIS � <br /> APPLICATION AND KNOW THE SAtdE TO BE TRUE AN�CORRECT.ALL i <br /> LEG/�LDESCRIPTIO!IOFPPOPERTV ISHOWNUELOW ONRI�ACHFOURLOPIES� PROVISiONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , <br /> � � A�Y�{ WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIIJ OR <br /> LOT�_ 9LOGK �F /� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BY THc � <br /> 01NNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH '� <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE �� <br /> CONTRACTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> SIG4RTUR[OFCONiRACTORORAOTHORREDAGENi DNiE <br /> _ S 3/ IST D�. � w � ��n,1 {�1~---�__ <br /> /' "; PRWEQ�DORESS • � <br /> ( � pFPLICnNTS CITY BUS�NESS IICENSE NO.ANO BUSME55 NAGE <br /> I ��'i pLUMBING MECHANICAL <br /> � � � ' NO. TYPE OF FIXTURE OR REM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC-NHNDLG UNITS-H.P. <br /> ��, - FORCEO AIR S`.'STEMS-B.T.U. M E.A. <br /> / BATHTUB <br /> �I ��' LAVATORV(WASH BASIN) - UNIT HEATERS-B.T.U. M <br /> I SHOWER � - � CLOTHESDRYERS _ <br /> � KITCHEN SINK 8 DISP � - VENTILATION FAN _r__ <br /> � �� DISNWASHER �'� - / RANGE HO00 <br /> I �� LAUNDRVTRAV _ _ WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> ! METAL FIREPLACE 8 CHIMNEV - <br /> URINAL <br /> � �� DRIP:KING FOUNTAIN FIREPLACE INSERT <br /> I !y� FLUOR DRAIN HEAT PUMP <br /> �� BACKFLOW PREVENTERS X GAS PIPING <br /> � ROOF ORAINS-RAINLEADERS EXHAUST FAN _ ' <br /> '=1�' SINK(SERVICE-BAR,ETC.) � �ZL�D S �n� <br /> �' SUB TOTAL 8 -� SUB TOTAL S � '- <br /> � PERMIT 5 <br /> PERMIT 5 <br /> - TOTALFEE 5 - TOTALFEE $ - <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOACR RERRSEIORGN SIGESETOACN / P�C�ECKNU���/�� FEE`��' ;f RECEIPi�O <br /> ZO �0 � L <br /> usezose LOT�REA VPC�NTSITE FEES VAL'JATION FEQE <br /> �) � ; Ci� � � �) n <br /> - , / BUIL�ING f6Q Q � L � <br /> ttPEdiCONtS.�LIOWABIE ttPEOfCON4.ALNAI ��nal>�Y �oaPNuwcuxrts <br /> 3 PLUMBING � <br /> SREOFBLDG. NO.OPSTOHIES OASEMENi MECHANICAL ��D i <br /> izsc sF +� � ,� — , <br /> � Y � <br /> OLGUPANCYLO�� FlR[SCRNKlER5RE0D I�E�G4TLIMILATION ADOITIONALPLANCHECK �' <br /> 7�/ ' <br /> IJ A/J ��u OTHER � <br /> FE�50 PORSFRINKLEPS � <br /> STAiE BUILDING SURCMARGE L/Ll�j <br /> IMRKEOY PLANSAPPIIOV(DOY CITYDFEVERETT PUBLICWORKS O � � � <br /> �ye LOCALSALES <br /> ,/� TAX CODE IS 3705 TOTAL n � ��r 1 <br />