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APPLICATIO: � FOR CONSTRUCTI�:?��N PERMIT eV� <br />TO BE COMPL[TED IN INK—PLFASE PRINT <br />Il�r Everprrrn <br />cn v or <br />everett HEATING SYSTEAI: f] GAS I] EIECTRIC ❑ <br />BUILDING DEPARTMENT <br />25g-gB10 <br />� DEMOLITION � i COMBINATION <br />owNEn IANIAoortEsS <br />� n �.. — --. ,� . . <br />nflCllll[G70fi0E5�GNER MrII�DDf1C55 <br />murnn�.ca+uinr.mn MNIADDIICSS <br />i I BUILDING <br />CItY <br />�U� <br />CIIY <br />CI1V <br />cirv <br />I I MECHANICAL I I PLUMBING <br />zm rua+e <br />_252-34'ii <br />Z�p PHONE <br />ZIP P110NE <br />71P PIIONE UCENSE � <br />uen�nrucniccwmneion uminooness arv zm �•�����r <br />N.W �aftr�ta�+r_Tj... 3l(0� tu. v.t Evr 7.a1 ZS 1-S3;I <br />,�� o,a��,umnr.ion Mnnnooness em zm PIIONE <br />. <br />I I SIGN <br />NpI1N <br />I 1 ADDI7�ON � � ALTERATION I I REPAIR � I DEMOLIIIOIJ ! I WOODSTOVE/��RPLINSERT ❑ BUILDINGRELOCA I <br />COMAGL PERSUN AND PIIONE NC. <br />pNCF Of WOPK v O0 � <br />WpRK�H[)SOU��Ef TAGEINVOIV[0 <br />i»u �xs F`•'''•• a/i/ <br />�useornmiowc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEDT ALL <br />tccnl oe6G��rtroH oF ri io�•� <br />LOi OLO(:N <br />ri�aecr noon�ss <br />Zory. Uira�n;ti R <br />PLUMBIN(i—� <br />NO. TVPE OF FI%T <br />WAT[Fi CLOSET (TOIL <br />B�T4TUB <br />LAVATORV !WASH �A'� <br />SIiOWER <br />KITCIIEN SINK 8 DISF <br />DISHWASHER <br />L�UNDRYTRAV <br />CLOTHES WASHER <br />URIkAL <br />DfiINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PR[VEN� <br />ROOF DRAINS—f7AIP <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC . <br />.owon nnncr� FOUn GoriEsl PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br />or NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br />PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORI2E0 BY THE <br />OWNER OF THIS PROPERTY TO PERFORfA THE WORK FOR WHICN <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C(:NTi7ACTORS LAW 18.27 FCW ANU 296200 WAC. <br />SIGN�TUR[IX'CONTOACTOfiOfIpUTHORIZEDlGENT OATE <br />x �Q. ' �/�y/�� <br />KNI q�./ <br />�PMICANiSQIY0U51NE5 LICENSENO.�NDBUSINESSNAM[ <br />OR <br />SUOTOTAL $ <br />PERMIT $ <br />TOTALf-EE $ <br />FOR OFFICE USE ONLY: <br />ff1UNI5C10ACK PE4R5[LO�CN <br />��;������ iornnen <br />h�'IOICOIIISAIIOW�PI[ IYfFUfCON51.pCiUM <br />9]f O� OLDF. NDAF 510RIE5 <br />rv � I IPANf.Y IOM fIRE SPRNNIERS Rf <br />ncnsor+von smnrviees <br />nnn�,e m � r�,.r.s nrrnovm nr <br />�ED AIR SYSTEMS—B <br />HEATERS—B.T.U. M <br />fHES DRYEHS <br />f ILATION FAN <br />GE HOOD <br />ER HEATER <br />)D S10VE <br />PUMP <br />f�IPING <br />1USi fAN <br />5�p@5(ipAf,K PL�NCNEGNNUn�ucn <br />vncnNi snr FEES _ <br />OUIL�ING <br />acur�rrr rAaRMluNf.�ixirs - <br />cnmr p�UMBING <br />ons[MEm MECHANICAL <br />ME�GntnraitnnoN ADDITIONALFLANCHGCK <br />OTHER <br />STATE f�UILDING SUI7CHARGE <br />CI�Y OF EVERETT ruouc wonKs <br />�or.n� sn�es <br />TAX COOE IS 3105 TOiAL <br />M <br />SUB TO <br />PERMIT <br />$ <br />S <br />$ <br />REC[IPT NO, <br />i <br />