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.,.�. <br /> � <br /> i <br /> � y� � � �,-<«�« <br /> APPLICATI�L.� FOR CONSTRUGTi�N PERMIT � i <br /> TO BE COMPLETED IN INK—PLEASE PRINT � � <br /> rne[mrgrren � <br /> �u2�C� __� ! <br /> cir. oF � <br /> �O everett HEATING SYSTEM� ❑GAS i�ELECTRIC ❑_ _ I <br /> �j� BUILDING DEPARTMENT � <br /> G yy� 259-8810 ��� � <br /> y DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN �` <br /> OWNER MAILADDf1E55 CIiV � liP P��ONE <br /> y�� K�l � � P�N: C�.�--4�� P•o a�x��si �,,.K-rr �8zo , 33� -soar <br /> � TCN�NT MAIL��ORESS dtY ZIP PMONE <br /> �� � CILY Zlf' PNONE <br /> H W� ARCNIIECiORDE5IGNER MAILA�DRE55 <br /> �y{�x <br /> •"Q � GEN[Net CONTR4GTOH MAtL ADDRES`. pTY Z�P PHONE LICENSE� � <br /> � � <br /> O N pw.�.cr I <br /> ��g MECIUNICPLGONLMCiOR M�IL�DOf1[SS CILV 21P PNONE ULENSEI � <br /> ���IIIY <br /> Z y� PWMpINOGONTRAGIOR MNIRODR[55 QiY ZIP PHONE LICENSE� I <br /> 9 I <br /> 1 I <br /> �y y cussorwoRK . � I <br /> ��y �C NEW �� ADDITION � ALTEFATION REPAIR DEMOLITION � WOODSTOVE/FRPL INSERT BUILDING RELOCATION I <br /> LONTAGT PERSON AND PHOKE NO. � <br /> ��� 2 / 0 SV ;j�\�✓.-C_ ��i <br /> CONTR�LTPR�GEOFWORK /JSSCGI <br /> yN OESCRIBEWORXAN�SW�fi[FOOIAGEINVOWE� <br /> O p� � , � .f_:y ��cs;.�...« 1350 s� �h <br /> .. crci+— s�^�- --- I <br /> aaoroseouseoceuaowc I HEREBY r,ERTIPY THAT I HAVE READ AND E%AMINED TNIS <br /> 5.^ ', f� �1 �y�h„�„� APPLICATION AND KNOW THE SAME TO BE TRUE AND GORRECT.ALL I <br /> t' PROVISIONS OF IAWS ANO ORDINANCES GOVERNIN6 THIS TVPE OF ; <br /> IEGAlAESCRIPiIONOf PHOPERiYISH0IVNOCLOWOBAi1ACNFOUFCOPlbS) yypRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iat__�_ BLOCK oF NOT. THE GFiANTING OF A PEFMIT GOES NOT PRESUME TO GI\'E <br /> � <br /> AUTHCRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY , <br /> P��' e� U4 w,v R�< <- �'#'u'��'•^ �` �"�� �1°'�i�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> � lJ. q�i,_A�,� -�a -{4 Plo-t' 3�� � ftw•��A i♦ OWNER OF THIS PROPERTY TO PERFOFM THE WC1RH FOR WHICN <br /> APPLICA710N IS MADE AND I COMPLY W�TH THE STATE <br /> CONTRACTOAS LAW 10.27 RCW AND 29620J WAC. <br /> u 1M�� �Z �S P1.:Is ,� IUG 1., S•\0� �-�� �'�� SIGbAtUREOFCONiRALiORORAUTHORIZE�AGEM1 onre � <br /> X�a- ��_�� <br /> . PROJECT�DOFE55 � qppLlG�Ni5C1iY0U5ME55LICEN5EN6 ANOBUSMESSNAME <br /> � � S�L �ncf Vi�.a R��C � <br /> , ��� VtUMBINO MECHANICAL <br /> � TYPEOFFIXTUREORITEM FEE NO. TYPEOFE�UIPMENT FEE <br /> � � N�. _ <br /> WATER CLOSET(TOILET) WC—A�HNDLG UNITS—H.P. <br /> �ATIi7UB FOFCED AIR SYSTEMS—B.T.U. M E.A. <br /> � ; �—� � LAVATOFY�WASH9ASIN) UNITHE�TERS—B.T.U. M <br /> I _ SHOWER CLOTNES DRVERS _ <br /> � KITCNEN SINR 8 DISP VENTILATION FAN T_ <br /> i � DISHWASHER R�NGE HOOD — <br /> �I � ' 1 LAUNDRYTRAV WATER HEATER — <br /> CIOTHES WASHER WOODSTOVE <br /> URINAI METAL FIREPLACE 8 CHIMNEY <br /> DRINKMG FOUNTAIN FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUA1P <br /> �� GAS PIPING - <br /> . BACKPLOW PREVENTERS <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN _ <br /> SIN"�SERVICE—BAR,ETC.) <br /> �a1�� — <br /> I � _ SUB TOTAL 5 SUB TOTAL S � <br /> � �'�� PERMIT $ PERMIT 5 <br /> \ TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> RECE�PT rv <br /> f"RONLSET�RCN R[Af15[18AGK SI�SSET�ACN PIAROif /NOMP;P FE[ / � <br /> ''J /�y f/� <br /> � ��� L� � � Y O� C C^ �JV��Y � � <br /> use zor+ �oi nnen VRGNNT SR[ FEES VALUATION FEE <br /> �-1 Y�s Gy s�s " ' <br /> euaoir+c <br /> iMfOiLONiS0.lLOWABLE iY1:OiCONSVdIpN uc6P nn M1OO�oNllr'2uV'�'�� - p'�� _ <br /> � PLUMOING � ' <br /> ' _ �N �- � <br /> SizC oF BIDG NO.OF STORIES BASEMENL MECHANICAL <br /> �y'�J Sf 2 ND <br /> pf,Gl1�ANCYLOAO (IRESCRNHI[RSP[O'0 HEIGMTLIMITATiON <br /> ADDITIONAL PLAN CHECK <br /> � NJ � OTHER � <br /> H[ASON�Ofi 5�I11liMl CI15 �/� <br /> STATE�NLOING SURCHPRGE � (J <br /> �vm.r rr ._. - ainr+snvr.,oveonv CITY OF EVERETT puouc WORHc G(/ �� <br /> LOCALSALES Nn� ;� t <br /> J� ✓2��i L TAX CODE IS 3105 TOTAL �� / <br />