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� <br />APPLICATION FOR CONSTRUCTIV�1 PERMIT ��"�" <br />TO BE COMPLETED IN INK—PLEASE PRINT <br />N�'�'`�� e <br />fhe Evergreen <br />CITV OF <br />everett HEATING SYSTEM: ❑ GAS ;SI ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITIDN COMBINATION BUILDING _ MECHANICAL PLUMBING SIGN <br />/ G - -- <br />PLUM�INGCONiRACTOR M1I�ILFODPE55 CRY ZiP PMONE IICENSE• <br />jq�»C � ���n✓c� <br />CL�SS OF WORN <br />NEW �C ADDITION .� ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />I CONTACT PERSON AND PMONE NO <br />PhiCE OF WCRr, <br />D[SCRID1[ N'ORK AN/450ULARE 1F.00TAGE INVOIV[� <br />�Ci�t�i��)/I il��y�tl 510.��`CQ� <br />PROPOSEU US[ Of BUIIDING <br />'1'��q�(._�127(� S <br />L[G�10[SLPIPT ONOF PhJPERTV ( 10WN �EION <br />i <br />ior c�4 e�a.K �n�,� oF <br />�ooaess – <br />l� l��n�,n�,� �Q�e l,:v�^�t'-� d1% yf�a01 <br />�BING <br />TYPE OF FIXTURE OR ITEM FEE <br />WATER CLOSET (TOILET� � <br />BATHTUB � <br />LAVATORY (WASH BASIN) <br />SHOWER f <br />KITCHEN SINK 8 DISP _ <br />LAUNORYTRAY <br />CLOTHES WASHER_ <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (ScRVICE—BAR. ETC <br />PERMIT <br />WTAL P <br />FOR OFFICE USE ONLY: <br />FPONi5ETB4CN RERPSETOACK <br />Z� z.v <br />�ISEZON[ LOTMEA <br />R- aoo <br />ivPCOFCONISPLLOWABIE lYPEOfCON51RLTUAL <br />Si2[ OF B1.DG <br />� lf Q <br />OCCIIPANCY LORC <br />._.11..']— <br />REASON FOH SPR <br />INIANE BY <br />�� �� <br />NO. OF STOAIES <br />flRE SPRNKLERS <br />N� <br />PLANSAPPROVE� Y <br />�I <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br />�i WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIIJG OF A FERMIT DOES NOT PRESUME TO GIVE <br />/ AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />/ OTHE7 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOFi WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RGJJ AND 296200 WAC. <br />SiGNRTUREOFCONTRACiORORAUTHOHREDAGENT DATE <br />X �� ���� 3- 7 -� 1 <br />APPlIL4Ni5tlT INESSL�:.ENSENO.ANDBUSM[SSNAM[ <br />TYPE OF E�UIPMENT FEE <br />NC—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RHNGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEV <br />FIREPLACE INSERT _ <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />S�DESEiBRLK PIRNCM[crc �m�n <br />/ 7 <br />vncnN*srte FEES <br />n BUILDING <br />OLCu»Ncr NO�iVMLLivGuvrtS <br />caa'° pLUMBWG <br />BASEMENT I MEGNANICAL <br />Na <br />HEiGMT LiuirATioN ADDITIONAL PLAN CHECK <br />2�, OTHER <br />STATE BWLDING SURCHARG@ <br />CITY OF EVERETT PUBUC WORNS <br />LOCAL SALES <br />TAX COOE IS 3105 TOTAL <br />SUB TOTAL 3 <br />PERMIT 5 <br />TOTALFEE 5 <br />iEE � I � %3I RECEIPT <br />L <br />��� <br />