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����� <br />1� APPLICATION FOR CONSTRUC�'�ON PERMIT <br />fho Er.grean1 <br />C�TV OF <br />everett <br />BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />'� DEMOUTION LJ COMBINATION I BUILDING �CHANICAL � 1 PLUMBING <br />Y\,:r'��C% , l �i�_��� ni�n iti .� LI'�)� I — c� �.� 'f't'\'r� ���wU(��/! 1� �L <br />�RGHILECTOBD[SIGNEfI MMLAODR[55 <br />a«,c-f.���,o� —yq�{�pr���fURAI GAS, INC. <br />.—�� 259�5492 — 35r »�p_����II' <br />MEGInNIGALCONipnGT011 �.����2e� <br />�cDougoll <br />Ev�ret f.JYn4dyeor�-pq2oi— <br />flUMO!NGCONiRRC10R MAIV.DDii[SS <br />U 5 F W RK <br />CITV <br />ciTr <br />CI1Y <br />cirv <br />ZIP PIIONE <br />zm mwNe <br />z� -3LL�, �� <br />�. <br />ZIP P ONE <br />zin ruor�e <br />IICENSG � <br />ic� <br />I�CENSE N <br />everett <br />� <br />CJ SIGN <br />C 5 O 0 <br />I; NEW I 1 ADDRION _ CTFRATION I_1 REPAIR ❑ DEMOLITION I I WOODSTOVE/FRPLINSERT ❑ BUILDINGR[LOCATION <br />TENANT IMPf10VEMEN10R INiEN�Ofi fi[MOOEL ONIV �ONT�CI P[RSON AND PIIDNE N0. <br />CONiRACT VRICE OP YJOOK: /��� � v� � n_ <br />�ESCRIpEWOfy(ANDSOWREF F�N�OWED '�/ I7�I <br />PROPOSEDUS[OFOUtLDING (��� <br />LEGr1L DESCRIPIION OF PROPEIiTY �SIIOWN 9E10' <br />LOt OLOCK OF <br />PLUMBING <br />NO. TYPE OF FIXTURE OR I <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY�WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOiHES WASHGR <br />URIN�L <br />DRINICING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PRFVENTERS <br />ROOF �RAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />rnoNrsclnncK <br />USEZONE <br />irrc nr cor�si. auownei[ <br />size or mx <br />�iCCUPAIICY LO�O <br />IIGGSON FO� 51'RINRL[RS <br />APPUC�tIONACC-OY <br />Foun covies� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION Af1U KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPL[TED WITH WHETHER SPECIFIED 11EREIN OR <br />NOT. THE GRANTING OF � PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS7FUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE 6YORK F09 WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THC- STATE <br />CONTRACTORS LAW 1027 RC\N AND 296200 WAC. <br />SIGHAiUR[OFCONTf1�C70RCBRUT110N2ED�GENT DAtE <br />X�. �� <br />APPLIC�HtS GiY pUSINF.55 LiCFNSE NO ANp pUS�N[55 NAME <br />XIYI V H�. <br />TYPE OF EOUIPMEN' <br />NC—NIiNDLG UNITS—H.P. <br />FORCED AIR S'fSTEMS—B.T.U. <br />UNIT HEAT[RS—B.T.U. Id <br />CLOTHES DRVEHS <br />VENTIfATION fAN <br />RANGGHOOD <br />WATER HEAT[R <br />WOODSTOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACEINSERT <br />H[AT PUMP <br />SUB TOTAL $ � <br />PERMIi $ <br />TOiALFEE $ � <br />REAliSEtHACN Si�E5f11�nGK PL�NCIIEGKNUM9f:li R:[ <br />C <br />tornnen vncnNtsne FEES <br />I.I YES f t NO out�oiNc <br />iVPEOf�ONSI.ACIWL trcuraxcr r�OprnnWxGuxnS <br />cnwv <br />ALUM�ING <br />NOOFSIOFIGS BASEMkNI <br />MECHANICAL <br />I_l YES f I NO — — <br />FIRE51'RNNlEPSlIEO� NEIGNTtIMiTALION OTHGIi <br />❑ Y[S f I NO <br />— . STAT[ �UILDING SUf1CHARGE <br />STATE ENERGV SUfiCI UH. �E <br />ainNsnrrnoveonv CITY OP EVERETT <br />PUBIIC WOl7KS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />E.A. <br />RECEIPT NO. <br />VALUATION FEE <br />� <br />i <br />; <br />