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_ � , <br /> APPLICATIOK. FOR CONSTi RUCTI�.t�l PERMIT �'°''«'" <br /> � em��e..•.p��� TO BE COMPLETED IN INK—PLEASE PRINT <br /> ciTr oF <br /> everett HEATING SYSTEM: GAS O ELECTRIC U_— <br /> BUILDING DEPARTMENT <br /> 259-8010 I/ <br /> DEMOLITION COMBINATION BUILDING �'MECHANICAL PLUMBING SIGN <br /> owrvea uni�nooaEss Grr �ii� i'HONC <br /> 7 ll( � <br /> ��'�' ' � �'�r ��ibx�til��� ( 1' r�i���-t �,�'�,�_����-,�r.�%�_ <br /> ��� llilANi MAII�DDflE55 CITV ZIP PNONE .. <br /> ARCMIIEC,�iO�R�DE51GNtR 41�LL��DRE55 GiV ZIP PIIONE <br /> � � G@lERALCONIRhCtOR M4ILADDRE55 CITV ZIP PNON[ LICENSE� <br /> r� �e �- 2 = ' , '�� 3IIG d1c�L'J' d7�� 4c� 9�'�/ ���3.3/ X1Ur�f,ic�J11G3k �- <br /> MCCHANICAI LONTPAGTOR 1AML PODRES$ CITY 21P FHOHE UCENSE• <br /> R�� ����rcc� <br /> PlUM01NGGONiqnCTOR MMLRD�FE55 CITY DP PMONE LICENSE� <br /> �/.I"L > <br /> CUSS OF WORK <br /> �,� ,�' NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPLINSERT 6UILDINGRELOCATION <br /> FI ]-- �COlNTPCiPE�50NANCPHON[NU -. <br /> Q� co.ira.c*vaiwonwoa. � .��i��(�id /�l(C,�,C�ZIZC ��-SIA.� _ <br /> � DESCRIBE WOPK ANp SIX1PR[ OO1RG[INVOIVE� � <br /> � rn , c ,�..�� , �; ��-;'� �� / <br /> ���.}}F v oroseous oFeui�pir� [ I� n ,, /� I HEREBY CERTIFY THAT I HAVE FEAD AND E%AMINED THIS <br /> �� ' ' � � �I I 1�."/�-� � l Ll,C1��y f Z�g APPLICATION AND KNOW THE SAME TO BE TRl1E AND CORRECL ALL <br /> �[cnioe � ir*�orvoF oreA*�isH ee,owonnnncHvouacoaics� PROVISIONS OF LAWS HND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi e�ocrc ov NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> � ��j 1�, A U TH O R I T V T O V I O L A 7 E O A C A N C E L T H F P R O V I S I O N S O F ANY <br /> �q �1 37- � - �d�- OTHER STATE OR LOCAL LAW REGULATMG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUi.TION.THAT I AM AUTIIORIZED BV THE <br /> '� �` ' OWNER OF THIS PROPERIY TO PERFORM THE WORK POR WHICH <br /> APPLICAiION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACiORS LAW 1827 RCW AND 296.200 WAC. <br /> SIGNPiUPEOFCONiRACtORORPUiHpRIZCDAGENi OFIE <br /> �1�f(D �!?l�_i��Ll�� ��"Y� �ZL'1{��N��_-fl,u}'�ILB<°��, <br /> vaaFr,i�oo�ess <br /> PUCRNTS CITV AUSME55 UGENSE NO PNO BIISME55 NAME <br /> PLUMBING MECHANICAL <br /> /��\� NO. TYPE OF FIXTURE OF ITEM — FEE NO. TYPE OF EOUIPMENT FEE <br /> I WATER CLOSET(TOILET) A�C-A�HNDLG UNITS-H.P. <br /> , � � BATHTUB — FORCED AIR SYSIEMS-B.T.U. M E.A. <br /> � LAVATORV(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> �� SHOWER CLO7NES DRYERS <br /> KITCHEN$INK 8 DISP VENTILATION FAN <br /> I �� DISHWAEHER RANGEHOOD <br /> � LAUNDRY7RAV WATEH HEATER <br /> I� _ CLOTHES WASHER WOOD STOVE <br /> � I ��' URINAL METAL FIR[PLACE 8 CHIMNEV <br /> � DRINKING fOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACHFLOW PREV@NTERS GAS PIPING <br /> . ��1�' ROOF DRAINS-RAINLEADERS EAHAUST FAN <br /> . SII�K(SERVICE-BAR,ETC,) <br /> I _�— <br /> 1— _ <br /> SUBTOTAL $ SUBTOTAL $ �/� ; <br /> PCFMIT $ PERMIT $ / <br /> I ,_'_l TOTAL FEE $ TOTAL FEE $ <br /> �� FOR OFFICE USE ONLY: <br /> - fBONiS[iBRCK ��Ea�SETBACN SIOES[TBRCN PIANCNEf,hNl1M�EN PEf FECEIPTNO <br /> 3'S �D <br /> usezor+e �ornnu vac��+rsire FEES VALUATION FEE <br /> Bt11L01NG <br /> iVPFOFLOXiSALLaWFBI( iVPlO�GU451ACIIlo1 cu>wtr xOxOx'uu�iao���� - ' —-- - � — <br /> �9`"1° PWMAING <br /> 9ZEOFBLW. NO.OFSTONIES BRS[MENi MEGHANICAL ��� <br /> OCWP�NCVIOAD FIRESPRNNLERSREO'D NEIGHTIIMItAiION ADDITIONALPLANCHECK <br /> O7NEF <br /> I�USON F0115PRMKlERS --r- <br /> STAiE BUILDING SURCHARGE <br /> imrn��.o. viaHsnrvnovrno. CITYOFEVERETT rueucwot�Ks <br /> LOCALSALES � <br /> TAX CODE IS 3105 rorn� S S� � �'� <br /> , <br />