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APPLICATII.rV FOR CONSTRUCI �ON PERMIT <br />CIT'( OF EVERETT • BUILDING DIVISION � <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />fl DEMOUTION Kl COMBINATION � BUILDING ri MECHANICAL r l PLUMBING fX SIGN <br />PROJECT ADDRESS <br />10330 9TH AVE. [4 EVERETT, h'A 98209 <br />°wNE� Mu��ooaEss ciTv <br />z1" rHONE <br />THEODORE E. S SHIRLEY D. HARCHENKO 3823 KRODfER AVE EVERETT 2�2—g72p <br />TENANT MAIIADORE55 CITY — <br />21P i'MONE <br />sarie — <br />AFCNrtf.CTOROES�GNGq MApAD�RE55 ���y <br />lIP pHONF — <br />ROBERT R. RICHARDS PO BOX 916, ENUMCLAW, WA 98022 (360)825-1569 <br />GLNCRAICONfP�Lipq M4ILAODRESS ���y <br />l�� f NO4[ SinT[ I If,MSE • <br />DON R. KIRKMAN PO BOX 816 AUBURN, WA 98071 (206)83?-7910 KIRKMANDR150LS <br />MECH�NI�q��ONTPnCTOR MAIIRD�RE55 ��ry <br />// � Z��' PIIONE SiAtE LILENSE • <br />'"•��1� _%a�.4.L: .� ���: � / <br />_%vl=.�>;-/;i, ,—,z-L �,.<<<� T �7s�-.jir4� �%�S -.Si:�/,c <br />PLUMBINGCONiRAf,iOp MAII�DURE55 ��n. <br />Z�P PNONE STpiELI�ENSE• <br />cuNlneGT PRIGf OF WpNK <br />5550.00O.GO <br />OESCRiBE WORK An�D SO�nRE FppT�GE IVVOIVE� <br />oF <br />�tt.�L OESCIi1PT10N OF PROPERtt �SNOWN BI <br />lOT 9lOCN <br />EE ATTACHED <br />•TfAGN <br />P�RCELT�%IU.NJMBER <br />'47R04_7_007_001)S <br />CONSTqIKT�ON IO�N LENDER, �DpqESS. TElEP110NE NUM�EB <br />MO• TYPE OF FIXTUAE OR <br />p � WA7ER CLOSET (TOILETt <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLV: <br />fRONTSFTARf.H RI'qPSF.TBACK <br />/O � <br />IISE 20NE <br />�' � <br />HfIGIR LI! Lp �/N <br />f <br />OCCUPRNCV Np pt5 <br />� �UG 2 <br />FIRE RLMyM,�`R[�p'D <br />�ine srnir��n nr.o i <br />Yt�'� <br />i rre or r.oNs r <br />J�-�V <br />lOtPpEA <br />NO OF pWElL1NG <br />UNILS <br />n�ov <br />nv <br />HEATING SYSTEM: � 1 GAS �1 ELECTRIC I I <br />CONTACT P[R5� N AND PUONE NO <br />---- --- c�v.t�v�a GJL-7 /LV <br />S I HEREBV CER7IFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOIN THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF �qWS AND ORDINA�ICES GOVERNING THIS TVFE OF <br />WORK WILL DE COMPLI[D WITH WHETHER SPECIFIED HEF7EIN OR <br />owEs� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME t0 G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF LNY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAIION IS MADE AND I COMPLV WITH THE STATE <br />'C(ONTR���B,2���zys.zno wnc. <br />�SIGNRTURE � pq1E <br />C�TY BUS�NEKS IICENS@ Np. <br />NO. TYPE OF EOUIPMENT <br />A/C — A/HNDLG UMITS — H.P. <br />_ FORCEDAIRSYSTI=MS—B.T.U. M E.A. <br />EAT PUMP <br />U HEATERS—B.T.U. M <br />CLOT 5 DRVERS <br />VENTILA N FAN <br />RANGE HO <br />WATER HEATE <br />WOOD STOVE <br />METqL FIREPLACE (W D BURNING) <br />FIqEPLACEINSERT(W00 URNING) <br />GAS FIREPLACE <br />j GAS RANGE <br />CaAS PIPING <br />[XHAUSTFAN <br />SUB TOTAL $ <br />PERMIT y <br />TOTAL FEE $ <br />SIDESETBRCN IPLANCIIECN <br />vncnnrsttc FEES <br />rts � ; r�o <br />BNIOMG <br />SRE OF OLUGRI <br />��^ Z � PlUM01.YG <br />845fMENi EAECIInNICAL <br />fi\ES �NO <br />ADDIIIpNnL PI.AN CH�CK <br />�^�/� _� O1NER <br />/ ����L � srnre ;�nowr, sunc�mnce <br />CITY OF EVERETT �nnnr.worKs <br />LOCALSALES <br />• TAX CODE IS 3105 TO7AL <br />rer 7Z �aeceirrNo <br />