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�i�E �, <br /> APPLICATION FOR CONSTRUC'► .ON PERMIT �VefP" <br /> mee��q��en TO BE COMPLETED IN INK—PLEASE PRINT � <br /> CI�V OF <br /> everett HEATING SYSTEM: ❑GAS �ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION CGMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAILADUR[SS CitV ZIP PIIONE <br /> JJ/�� R NNRT �dC� 3/u� TuINGlP AuE Ede� w,a. '�.�zoi Zs2-62ss <br /> iENANi MAILADDRE55 CiTY Z�P PMONE <br /> A(iCHRECTOR0E5iGNFR MAIIRDpPESS GITV 2iF PYONE ���� • <br /> ��yRN CA�/6[afs ��/L '/L+� �'lt� �'ea. �t/a �/�//)(, 767- _. <br /> GBIERRL CONTPPCTOR MFIL RD�RE55 CITY DP PMONF UCENSE� <br /> MECHANICPLC—O�N/�iRACTOR MRILRDORE55 CITY 21P F40NE UCENS[� <br /> Ou/�✓�/C� <br /> PLL'M�MGCONiRACiOR M�ILApORE55 QTV 21P PMONE LICENSE� <br /> dU/,(/c�.� <br /> CLFSS OP WORN . <br /> . . NEW X ADDITION . ALTERATION � REPAIR DEMOLITION WOODSTOVE/FRPL INSERT . �: BUILDING RELOCATION <br /> )(�`r -�QJ �"� CONiACi PERSON AN�PIIONE N0. , ,,r <br /> LONTiiR(:T PRICL OF WOHN �� �� A�� �S ��uw ��Z^ ��� <br /> O[SCRiBE\'rORK ANO SOURRE FOOTRGE INVOLVEO FX7r =��� <br /> AD BN f/ACF S7n,e!/ ClPS7R�:?.f AP �st: 7zo <br /> PRoroseouseoFew�ort+c 1 HEREBY CERTIFY THAT I HAVE FEAD AND E%AMINED THIS <br /> SiNGLc FAA4ZL ��`��.JF�� APPLICATION AND KNOW THE SAM,E TO BE TRUE AND CORRECT.ALL <br /> tecn�oesceianorvoFPHoreaTr�sNowNeeiowoanrrncHvouncowes PROVISIONSOFLAWSANDOflDINANCESGOVFRNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETNER SPECIFIED HEREIN OR <br /> �ot�if3 {" eiocn �� oF G vB7�� NOT. THE GRANTING OF A PEflM1T �OES NOT P(7ESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CINCEL THE PROVISIO�lS OF ANY <br /> TN� N��7yEN��� /OO C� ar- LOj' /INU OTHER STATE OR LOCAL LAW RI:GULATING CONSTRUCTION OF7 THE <br /> PERFORMANCE OF CONSTFUCTiON.THAT I AM AUTHORIZED BY THE <br /> OWNER OF iHIS PROPERTV TC PERFORM THE WORK FOR WHICH <br /> THC ^.�Jk�TNENS'TE�Q(y✓ /OU FCE� OF THE S�!{TN^ qppLICATION IS MADE AND 1 COtAPLY WITH THt STATE <br /> �/ p CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �/-r�C QGJ NAGF Or �T� BC��� I R��KC� SIGNRTURE OF COqTPAGTOR OR AUiHOH12ED AGENT DATE <br /> pazK .7oorr�o�u Td -r�v� u oF Ev�z�7'r X�'� lG .�IO������ -- <br /> VROJEGIADDRE�55 �> �+ — <br /> T � <br /> 'aCN+L�! p CU �� .fl� . �P�'��CRNTS .ITVBUSMESSUCENSENOAND�USINESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATEP.CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. �_ <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B:i.U. M <br /> SHOWER CLOTHES DHYERS _ <br /> KITCHEN SINK 8 DISP '�, VENTILATION FAN �_ <br /> DISHWASHER RANGE HOOD <br /> LAUNDRV TrIAY ' WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTnIN i FIqEPLAC[INSERT <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS —�—_ E%HAUST FAN ' _ <br /> SIKi'�SERVICE—BAR,ETC.) <br /> —� <br /> SUB TOTAL $ SUB TOTAL S ],S �Lf7 <br /> PERMIT 5 PEFMIT $ <br /> TOTALFEE S TOTALFEE S '� <br /> FOR OFFICE USE ONLY: ' • �-3 <br /> FRONTSEiDACK HE��SETBACK SIOItSETBACN PIANCNECCNl1MBFR FEF 7=. AEC[IP1N0 <br /> Za z� s ' Gi z � S(�`1 �0 1& 0 N�s7s <br /> use zorve �or nr,�n VRCANT SITE FEES VALUATION FEE <br /> ��� 1 37�� �• �� BUILDING <br /> �11ZS .��L ' s� <br /> tYPF Of L(1Ni5 AIIOWABIE TYP[Of GOHSi ALtURL occuv�x:r xo or VMw�ox�.ib <br /> �'4"+j ' PLUMBING U �ne� <br /> — � — D <br /> SIZE OF BLDG NO.OF STORiES BASEMENT MECHANICAL <br /> ' 1 ! S' ;a� <br /> BZ�� F rvv ADDITIONALPLANCHECK ,�p �� � <br /> OCGUPANC�'LOAp FlFESPFNNLERSREOD MEIGHTLiMITATiON <br /> r <br /> N NO Zg OTHEF <br /> RE450N FOR SPR�NKLERS <br /> SiATE DUILDING SURCHARGE y !ST <br /> IhT�KEBY PLANS�PPPOVEDBY CITYOFEVERETT PUBUCWORK$ <br /> /�} LOLALSRLES <br /> `ti� �� `7^' !, TAX CODE IS 3105 TOTAL yi✓ � o�%' <br /> �/-! �- -- <br />