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{4 .:�'� � .� <br /> APPLICA'TIOIN FOR CONISTRUC7y1bN PERMIT everE,« <br /> IheEvergreen TO BE COMPLETED IN IIVK—PLEASE PRINT � <br /> CITY OF <br /> everett HEATINGSYSTEM: ❑�3AS ❑ELECTFIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> � I DEMOLITION f I COMBINATION i _I BUILDING 1 J MECHANICAL 1�(PLUMBING (7 SIGN <br /> owNEn uni�noon[-s[� cirv zm viwr+e — <br /> �v�R�-rr �,r�xs � ���, v�r� oaz %fi0/dt� �VER1�r1� ' 98w1 �-�3�� <br /> lElIAN��n! MAIL�DDRES:i CIiV 21P PW�NE —' <br /> � (� <br /> RPLIIITECIOPDESIGNEO MRR�DDRES3 GTY Z'P PNON[ <br /> T/f� P�/IK�es� /�Jt(�nD, 6/i �vr�inrlr �V,�, �t, S1�/�rrt� , B�oL 3.h-- 7'�,� <br /> G[NERRLCONiRRGTOR MAILADDRE::i CITV IIP PHONE UCENSE� <br /> --dJ����IB_v��� <br /> MELIUNIC�LCONIOACIOR M�IL�DORE55 CIfY ZIP PHONE LICENSEI <br /> �TAr� �a��A. sTh r� I�9C l91 ti7 <br /> PLUMOINGCONIR�GIOR MAILAODItE55 CI1V ZIP PHONE �ICENSEI <br /> ST/AT� /'��e!-I• <br /> cuss a wonK — <br /> PC NEW IJ pDDITiON I..I ALTERATION I 1 REPAIR L.I DEMOLITION CI V/OODSTOVE/FRPLINSERT ❑ BUILDINGRELOCA710N <br /> CONIACI PERSON AYD i'HONE NO. <br /> contnacrvnicEorwonK �LyQLr��I/•Vv/t/a �J' 9_030a <br /> DESCRIBE WORK nNU SOU�RE fOOIAGE INVOIV[0 <br /> P/GN/L �NL�lt7'. /JS'Z s• F- <br /> � VROPOSEDlISEOFBUR0ING 1 HEREBY CERTIFY THAT I HFVF READ PVD E%AMINED 7HIS <br /> PVSuG P/C,{/!L S I��GTG9� APPLICATION AND KNOW THE SAME TO BE TRJE AND CORRECL ALL <br /> LEG�I DESCRIPiIpNOF PRUPERiV�SNOWNBELOW OR Ri1RCHFOUR WPIHS� PROVISIONS OF LAWS AND ORDINANCES GOYERNING THIS TYPE OF <br /> WOflK WILL BE COMPLETF_D WITH WHETHER SPECIFIED HEREIN OR <br /> iot oiocK oF Nqi. THE GRANTING OF A PERMIT DOES NOT pRESUME TO GIVE <br /> AUTHORITY TO ViOLATE OR CANCEL THE PqOVISIONS OF ANV <br /> � �/����1(p 7� 3� N., /Z� `� � l�l OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �'—� PERFORMANCE OF CONSTRUCTION,THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP6RTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 29620�WAC. <br /> cIGN11TUREOFGONTP�CTOROR�U7HOR12EDAGENT DATE <br /> PR0.IECTADDRE55 /l�Y��/ / /// �K/��" / J�„Ml ��W` ���NW�-s� 7�� IZ/ ��J /� <br /> � y� D I.PPIIC�TTCIiYBU51NE55Ll SENO.ANDBUSMESSN ME —� <br /> F� <br /> PLUMBIN6 MECMANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF'EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—fVHNDLG UNITS—H.P. , <br /> BATHTUB � FORCEI!AIR SYSTEMS—B.LU. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT NEATERS—B.T.U. M <br /> SHOWER CLOTHES DRVERS � <br /> NITCHEN SINK&DISP � VENTILATION FAN � <br /> DISHWASHER —T pANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL � METAL FIREPLACE 6 CHIMNEY � <br /> DRINKING FOUNTAIN FIREPLACE�NSERT � <br /> FLOOR DRAIN � fiEAT PUMP � � <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUS7 FAN , <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> '� 0 S ! � <br /> — <br /> � , <br /> � <br /> � T <br /> SUB TOTAL $ _/r���_ SUB TOTAL $ � <br /> _ _ PERMIT $ /� �m PERMIT S <br /> TOiALFEE $ � TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONiSEi6ACK qEAq5ET0�CN St0E5El0ACH Pll�NCIIECNNUMBER fEE PGCEIPiNO, <br /> USEZONF tornnea vncnrvisne FEES VALUATION FEE <br /> BUILDING ' <br /> 1YP(OfCONISRIIOWABIE LYPCOfCONSIALIUAL aturAMcr NadoMu�xGurmS <br /> mou� PLUM�ING n � <br /> / ��� <br /> S12EDPotDG NO.OFSTon1E5 oASE1AENI MECHFNICAL �– <br /> i <br /> OCCUP�NCYL04D �IRESPONNIElISOW'0 HEiGHTLIMIIqiION �D�ITIONALPLANCNECK i <br /> OTHE(i i <br /> ricnsor�ron srnu�rciEns <br /> SIATE OUILDING Sl1RCHARGE I ' <br /> �Nrnce er rinNsnrrnoveo or CIiY 0F EVERETT AUBLIC WOPKS � <br /> LOCAL SALES ' <br /> TAX CODE IS 3105 Tor�� � � <br />