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, 1 APPLICATI4:� FOR CONSTRUC7`:bN PERMIT PVefP« <br /> Ihe Evw9men TO BE COMPLETED IN INK—PIEASE PRINT � <br /> CITV OF <br /> everett HEATING SYSTEM: U GAS ❑ELECTHIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i I DEMOLITION I t COMBINATION I I BUILDING 4 i MECHANICAL I I PLUMBING I I SIGN <br /> uwnen Mnanoonrss cnv zm PHONE <br /> _j�'pT. D�G�i�� �rc�Rc-�r�e;� , e��/ �F �v,�rr,�vr�, •9�70/- 252-5�`lb <br /> TEN�NI MAILpUDRE55 CITY Z�P PHONE <br /> OWNt�' . <br /> �fiC111tECT OR pE51GNER MPIL RO�IlE55 CITY 2�P PNONE <br /> rr�� ,�xr�zs ��ll.c��c� �ii 5����T ��v�. �, s��Tri�' <br /> c�uenn�cor+mncton M/. �DORC55 CIIY ZIP P'IONE LICENSE� <br /> 6/fNo• Ld/L'S TR <br /> M[CN�NIC4LCONifUG101i MML�ODRE55 G11Y Zi� PHONE UCENSE� <br /> PlUM01NGGONfMCiOR MNL��OR[55 CIIY 21P PHONE LICENSE� <br /> C1�550f WOfiK <br /> �NEW I I ADD�TION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I .l BUILDING RELOCATION <br /> CONI4CI PGfiSON AN�PMOYE NO. <br /> coninncirnicrorwonK �,( ���� <br /> DESCNPE WOI1K I1Np SOU�11E FOOtr1GE INY ` <br /> p�lNrc SNEc�E� z� ���� ' � 152. s! <br /> . rnoroseoustoFeunowc 1 HEFEBY CERTIFY 7"HAT I HAVE READ AND E%AMINED THIS <br /> f�fR/1 L .i'iIICGTE�C – APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> , LEG�LDESGBIPiIONOiPROPE�7V151101VN�ELOWOR11TiACMFOURCOPI[5� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHlSTYPEOF <br /> . WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � ior mocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUidE TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW flEGULATING CONSTRU::TION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY iHE <br /> OWNER OF THIS PROP�RTY TO PERFORM THE WOHK FOR WHICH <br /> APPLICATION IS MADE AND i COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 RCW AND 296."e00 WAC. <br /> S�GN�IU�EOfCONIMGIOROR�Ui110HIZEDAGf:Ni DATE <br /> PIip1ECTA0�RE55 �—f—�''l-� ��f�� �`A�yfO <br /> �D �N �PPLiCRNTSy+rBU MESSUCE EVT�O�B INESSNRME <br /> PWMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NCrAIHNDLG UNITS—H.P. i <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � LAVATORV(WASH BASIN) � UN�T HEATER°—B.T.U. M i <br /> SHOWER � CLOTHESDRYERS � <br /> KI7CHEN SINK 8 DISP i VENTILATION FAN i <br /> DISHWASNER RANGE HOOD <br /> - LAUNDRY TRAY ' WATER HEATEF ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE&CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTEFS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> lRONiS[lO�GK ti[ANSEIOnCH SNESEiO/.CN PL�NCNECKNUMOEA fEE AECEIPTNO. <br /> use ror�� io�nnen vncnrvr 5uE FEES VALUATION FEE <br /> BUILDING ��VV ' <br /> IVPF p!`ONIS.AI}OWAPIF 7�O(CONST ALi AL �r�xtr xo a VnAtixcuxils � <br /> V ^/ ^'� PLUMOING ' <br /> � v � ' <br /> 512EOFBLDG. � NOAF5iO111f5 OnSEMENf n/v MECHANICAL � <br /> /�ao ° On/E � — <br /> � <br /> ADDITIONAL PLAN CIIECK � <br /> OCCUP�NGVLOn� FIRESPRNKL[RSf1E00 NEIGIIiLI1dItNIDN � <br /> i�� 3 N° o,���� ' <br /> ; <br /> nensorv von srmrik�ens —T <br /> STATE BUILDING SURCHARGE i <br /> ir��nneor ��� 5�'������on�' CITYOfEVERETT puoucwo�Ks � <br /> f;�„n� LOCALSALES <br /> � 0/���"/� TAX CODE IS 3105 iOTAL I� <br />