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��yi�y <br />07fx <br />C. H <br />9H[n <br />, <br />H � <br />K n <br />H� <br />OSO <br />'sl M �I <br />U1 F� <br />Zo <br />OMd <br />��g <br />� V (� <br />ry� <br />NH <br />8y <br />� <br />��N <br />�� <br />� <br />1 a� <br />C <br />� �� <br />APPL.�CATIC ) FOR CONSTRUCT' lN PE�MIT �� <br />TO BE COMPLETED IN BLACK INK—PLeASE PRINT �� <br />. _. - -- ------�i <br />HEATING SYSTEPd: J GAS J ELEGTRIC J ____ ____ _� <br />BUILDING DEPARTMENT <br />259-8870 <br />DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING _ SIGN <br />owr.=n <br />u�niiaoonc;� — -- ��.:ir --- . -----,,,,,,.—,i — <br />t=�R� /�4� �N 2�s�v— w�<i�.�v. �-< f: �; r _— <br />iEN4N1 MAILADORESS Giv ZIP FHONE <br />ARCHRECTORDESIGNtR NAiIP�ORE55 CITV IIP P��ONE <br />f,ENEMICONiRRCTOR MAILapCPE55 WTY ZiP PMONE SLRtELICENSE/ <br />OLGONTRRCTOR AI:IlA0DRE55 <br />�� W:d.-(l��- 3ll0•� <br />CONT0.AGi0R AIAILAOO�E55 <br />CONiR�LTPRICEOFWORK /I�('O <br />DESCNIBE WORk AND SOVARE FOOiAGE INVOLVEO <br />�noroseo use oF ew�on+c <br />k�Y—� <br />LEGALf'SLlI�PTIONOFPHOP[ YISHOWNBCLOWORRTiACNiWOCCAES� <br />lOt BLOCN OL <br />PARGELTR%10 NNABER <br />TVPE OF <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTflAY <br />f1:7tVJ <br />SINK <br />rEi[vror�E <br />PERMIT <br />FOR OFFICE USE ONLY: <br />�RONiSGTDAfN R[ARSETQACN SIpE <br />USEZONE <br />ivvt Of LON4. <br />srzeoro�oc <br />OCCUPANGVLORO <br />REASON <br />iutnn[ er <br />LOTAR[A <br />NO. OP SLORiES <br />FlRE SVFiNNLENS REO'D <br />FIRE AURIA RE00 <br />ri.nr�s narnw[o ev <br />r,,,, � <br />C�IV 21P <br />�vr �n 5 <br />CIIY 21P <br />PHONE Si4TE LICErvSt • <br />y y53.sz3r /✓c7�.�u /oi Kz- <br />PHnNo 51AtE�ICENSE� <br />CONiaCi PCRSON AND PNONF NO <br />i HEREBY CERTIFY THAT I HAVF READ AND E%AMWED iH15 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDIVANCES GOVERNING THIS TYPE Of <br />WOPK WILL BE COMPLETED WITi WHETHER SPEGFIED HER[IN OR <br />NOi. THE GRANTING OF A PERhUT DOES NOT PRESUI.IE TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP ANY <br />OTHER STATE OR LOCAL LAW PEGUTATING CONSTRUCTION OR iHE <br />PERFORM1IANCE OF CONSTRUCTION. THAT I Ald AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR V✓HICH <br />APPLICATION IS MADE A110 i COMPLY WITH THE STATE <br />CON7RACiORS LAW 1827 RCW AND 296200 WAC <br />X—�Z r� s-r Y 7� <br />— �i;17� __ <br />—:—.:—� - - _ <br />__�. <br />NO. I TYPE <br />AC—A HNDLG UNI15—H.r. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—O.7.U. M <br />RANGEHOOD .— <br />WATER HEATER . — <br />WOODSTOVE � _ <br />IdETAL FIREPLACE (WOOD BURNING) _ <br />FIREPLACEINSERT �� <br />�— — <br />hIEAT PUMP — <br />GAS PIPING — <br />FxHAuSTFAN __ . — <br />PL�NGHWKI:UM9CR I <« <br />VACANi51TE �eeJ <br />j-i YES . �. NO pUILDING <br />occurmn r,. or:,nwur.us�:s <br />tnour � � PWMBING <br />BASEMENi A7EGHANICAL <br />i�- VES '-� NO -- <br />M[iGHtuMrtAiION ADDI110NALPLANCHECK <br />__ OTHER <br />STATE BUILDING SUi1CHARG[ <br />CITY OF EVERETT ruouc wor�Hs <br />LOCAL SALES <br />TAX COOE IS 3105 TOTGL <br />PERMIT S /�j_ c'��- <br />TOTAI FEE 5 S�'CX� <br />