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APPLICATIO:����i FOR CONSTRUCT:;'.)N PERMIT everett <br /> ����t���o��r� TO BE COMPLETED IN INK—PLEASE PRINT • � � <br /> (:Il Y OF <br /> everett �HEATINGSYSTEM: ��{GAS OELECTRIC U _ <br /> EUILDING DEPARTMEP;T <br /> 259-8810 <br /> DEMOLITION � COMBINATION ! BUILDING A MECHANICAL IKPWMBING `. i SIGN <br /> E"�sKorniaM�IL�Dl1� %� U1f�I��ore.Y � ZIP� P��j— �ll�l <br /> �-NnNI M�IL�DORE55 GTY ZIP PHONE O <br /> ARCNIIECtORDES�CiNER M�II�ODRE55 Clrv ZIP FMOME <br /> 6FNERAICONTR�CTON M�0.�DORE55 UTY 21P PHO'lE IIGENSE� <br /> ME NIJI GONfR�L10P M�R�O RESS �—� /,� ITjY /��/� ^,yJ�/�� �,� �O�C�f�I / VON� ///�I� <br /> � L4 � H"�i+• i !I1/ <br /> T i_� � �« ��• Y VU Y �a.a.( s <br /> IIIMB�MGCONIF�GiON MMI�DORE55 GItY 21P P'tONE LKENSEI <br /> GUSS OF V/ORN <br /> NEW ' ' ADDITION � ' AITEFATION � �� REPAIR � � OEMOIITION �� I WOODSTOVE/FPPI INSERT I.�i BUI�DING RELOCATION <br /> ^� CONUGT PERSON ANO V1pNE NO. <br /> CONTRIICT VRILE C�F WORK �d� A�D• a� <br /> �ESCA� MVRNAHDSW�AEFOOT�GEINVOLVEQ JJA <br /> ' � � � ����/_f C <br /> �m useore o�nc . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ,�1J APPLICAiION AND KNOW THE SAME TO BE TRUE AND CORFECL ALL <br /> �,¢c.r0¢Scnivl a vao�ntv eiowon nn� �voun cov�es� � �� 1• PROVISIONS OF LAWS AND OFDINANCES GOVERNINC,THIS TVPE OP <br /> � WORK Wlll BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi etoc� oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAI lAW REGULATINO CONSTRUCTION OR THE <br /> - -- '--'-----�— PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br /> _..__-- APPLICATION IS MADE AND 1 COMPIY WITH THE STATE <br /> CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br /> SipN�TUREOFCONTR�CTOROA�U7HOR1ZE0AGENT DATE <br /> X <br /> ita��1°°���-i-more ��v �rc��+l� c� �'�"'�t�- <br /> � LiC�NTS .�lYBU5iNE55uCEN5ENO �NDBU5ME5SN�ME <br /> PLUMBIN6 MECMANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE . <br /> WATER CLOSET(TOILET� A/C—AMNDLG UMTS—H.P. � � <br /> BATHTUB FORCED AIR S`!STEMS—B.T.U. M E.A. <br /> LAVATORV�WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK d DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRVTRAV WATEH HEATER <br /> CLOTHES WASHEFi —� WOOD STOVE � <br /> URINAI ' METAL FIREPLY�CE 8 CHIMNEY � <br /> DRINKING FOUNTAIN FIREPLACE INSERT i <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PfiEVENTERS � _�_ GAS PIPING <br /> .._. '—_"_.____�.___—._'__..._—,..__. __" , <br /> ROOF DRAINS—RAINLEADERS EXH�UST FAN <br /> SINK�SERVICE—BAR,ETC.1 <br /> — --i— — <br /> _ __' <br /> — ' ___ —'_'—_�__'_ _____'—__'— — <br /> i <br /> _" " _'__"—'—"_'—"_"__'_—_' ___'_ _ _—_____"_ i <br /> SU8 TOTAL S SUB TOTAL f �C7 <br /> . ___ . _ . ..._ ..________ ____ __ _T ' . . . _. . � <br /> PERMIT S PERMIT E ' <br /> — ------------ TOTAL FC-E S --- — — — --�— tOTAL PEE E ' <br /> FOR OFFICE USE ONLY: <br /> rnONiSETBaLK tIE�R5ET8A�N SIDESE�en[N VUNCHEGeNUMBER FEE AECEIPTNO <br /> �isc zo�+e im�aen vnca�+r sirp FEES VALUATION FEE <br /> BUiIDING � <br /> iroFOr(�NtS�ltOw�PIF ivPF0i:045f��NAI rctcrwc. voao-muncuv��s <br /> °""tl° PLUMOING ' <br /> ;IZE O�OIpG NO OF STORIES BASEMENi MECHANICAL <br /> ^GCuo�vGviO�o 1'IpES�RNNlEASAEOD NE�G���uMiunON ADDITIONALPLANCNfCN � <br /> OTNER <br /> �f�SDN Fpf15�qINYIF�S ---- <br /> STATE BU401NG SURCNnRGE � <br /> ��„�Kr n. r�nHs���noveo er' CITY OF EVERETT PUBUC WORKS � <br /> LOCAL SALES � <br /> TAX CODE IS 3105 To*�� � ;� <br />