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�r������a�� r�� �����<7V� d'��tlV ������ l'\'1'll'll '�. <br /> TO BE COMPLETED IN INK-PLEASE PRINT <br /> c�lv� �%.. . <br /> �verett __ � <br /> �EATING SYSTEM: ❑GAS �J ELECTRIC !J._. __ - , <br /> LUILDING DEPARTMENT <br /> H n � 259-a810 � <br /> � �.r,y _DEMOLITION COMBINATION BUILDING _ MECHANICAL �'PLUMBING_ SIGN � <br /> � <br /> H 0\YNEH IdNLA00HE55 GLY liP PIIONE � <br /> � .'�n x � G'j Sfd X� .3�`��1r s' — I <br /> a H /��./'��G>,��I �,�„tA �z������G. ��f..�}' <br /> � y � I.IAIL AOpRE55 GTY ZIV PHONE <br /> � NANI // <br /> y �H 1�.,,,_�y�u� ls��r�' a�'�/ __�U`o, �.fir� ��� � uG'�- 3 ?�/�� <br /> CT(IllUESiGNE�i MAIL4�DPE55 GITY ZIP PHONE <br /> � y � � <br /> O 'rG' O PHONE LIGENSE a <br /> h'J H �TJ �,V�;IiALCONTRACTOrI MAIL4D�RE55 CIiY ZiP <br /> V1 H <br /> � O � OIUeVLCA�WNTR4CTOR h1AILADDHESS qiY ZiP FHONE LICENSE> � <br /> C�1 <br /> H t7 <br /> �pWGCONTRRCTOR 61AILApOPE55 LIiY ZIP PHONE LICENSEO <br /> H^ � g G��r, � � ��G�J ��cr�f �i'd 0(� c��'J- SJCZ? G�r �iI//9R`f � <br /> Y•V � <br /> H c'..L/SOFN'ON � <br /> � 3 liutW ADOITION . ALTEFATION REPAIR DEMOLITION . WOODSTOVE/FRPLINSERT BUILDWGRELOCATION <br /> H y CC1lTACi PERSON 4ND PHONE 1!O (��/ ��^�y <br /> �� f,Ct11RACi VRICE 0F WORK L(/�' _ .�,Qc (/ S��J %Y� <br /> H - // � <br /> � d� JrSCqipL WOfiKA110501ipRE F0p PGG RnDLVGD <br /> � t� r ��sfi!!rf��i—�i��j��" /Od� f7� <br /> [+7 �er,oroseouseoFouaowc � I HEREBY CERTIFY THAT I HAVE HEAD AND EXAMINED THIS i <br /> Z H p� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFEGT.ALL <br /> y � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OP - <br /> �e�n�oescnivrio�+oFPaoPearvisNowi�ee�owoaanscN�*ooncoaies yyORK WILL BE COMPLE7ED \VITH WHETHFR SPEGFIED HEREIN OR <br /> ,,,; o�ocK oF NOT. THE GRANTING OF A PERMIT DOE� NOT PRESUME TO GIVE � <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY I <br /> OTHER STATE OR LOCl1L LAW REGULATIiJG CONSTRUCTION OR THE � <br /> — — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFGRM 7HE WOHK FOR WHICH <br /> _ APPLIGATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 1827 RCW AND 296200 VJAC. <br /> — _ SiGl�ATOREOfC /CLO�UtMO EDAGBIT [)AiL <br /> � � <br /> I <br /> X//� � ��e �,'I <br /> rr.�icr�rr.r,�.nr - `�l�^/n/n� //�'9(/d4 ✓���_--- <br /> pup��GAN i 5 Ci1 V Pii5iNE55 LiGL�lS�tl0.A!!D�OSL'lE551lAL1E <br /> � �� - �U � <br /> - PLUMBING ME'HANICAL <br /> � d w�� FEE NO. � TYPE OF EDUIPMENT FEE i <br /> I ' ! NO. TYPE OF FIY.TURE OR ITEM _ <br /> ��.� �^�ATERCLOSET�TOILET) _ A�C—A'HNDLGUNITS—H.P. I <br /> BATHTUB FOiiCEU AIR S`.'ST[h1S—B.T.U. M E.A. _ <br /> iLAVATORV(WASH BASIN) __ UNIT HEA7ERS—B.i.U. M �I <br /> � ��` SHOWER CLOTHESDHYERS <br /> ��' KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASFIER RANGE HOOD __ i <br /> � LAUNDRY TRAY WATER HEATER i_ I <br /> ' CLOTHES WASHER WOOD STOVE ; <br /> I �e URINAL tAETAL PIREPLACE 8 CHIMNEY �� <br /> � DRINKING FOUNTAIN FIREFLACE INSERT i i <br /> FLOOR�RAIN HEAT PUMP '�.. <br /> . �� BACKFLOW PREVENTERS GAS PIPING �, <br /> i !� I ROOF DRAINS—flAINLEAOERS ExHAUST FAN �I <br /> SINK(SERVICE—B�R,ETC.� — I <br /> ' � �1 -- �— <br /> _- _ T <br /> ��i . SUE TOTAL S .� I — SUB TOTAL $ __ <br /> �, PERIdIT 5 /o ; � PERMIT S _ <br /> I � TOTAL FEE 5 /S, TOTAL FEe S <br /> �► <br /> � FOR OFFICE USE ONLY: <br /> Ii�C!!!S[1P�CK .'IEARSE�t1ACH SIDF.SEiG4CH PLANCIIl.C51J0l.1pFR �FE RLCEIP�NO <br /> ��„rzo�ve �oTnaEn vnCnursrte FEES VALUAI'!ON FEE � <br /> BUILDI"JG _ <br /> PtOfLOHi5dLL0YlA9lE 1YPEOFCONS1.AGtIIAt aav>v:v xoo�mvuu`mu�e,s -- -- �- <br /> ' caour PLU67�IIIG �.�' . <br /> sVcOFBLDG. NO.OFSIORIES BFSEMENt M17FCHANICAL <br /> OCGUPANCYLOAD HRESPPNNlER5RE0'0 N[IG��TlIMi1ATi�N ��-���ONALPLANCHECK <br /> OiH[R <br /> - ——__ ___—f—" <br /> -.���:.sow Fo�svraririer�s — <br /> STATE�UILOING Sl1RCHARGF <br /> , ,[w, ,;� � l �,n�:�:.����+ovr��i�r —� CITY OF EVERETT auouc woaHs <br /> � LOCAL SALES <br /> TA!( COOE IS 3105 TOTAL /S= �— <br />