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AF`PLICATIC 1 FOR CONSTRUCT 7N <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />PERMIT � <br />BUILDING DEPhRTMENT �EATING SYSTEM: �GAS U ELECTRIC U I <br />259-8810 <br />f 1 DEMOLITION I 1 COMBINATION !,�BUILDING 11(�MECHANICAL }CPLUMBING I i SIGN <br />OWNER M�IL ApDRE55 �ITV IIP � HONE <br />-o /� ^7 -7 <br />�1�1h1P � Y'[ � l�1��/ j '�✓ ��U! �_ �i.rill � 9C�'�c7 � �_� / ' / t �/ �% <br />�N�NT IMILADDRE55 CT' IIP P1qNE <br />�RCNI�Ef,TdIDESqNER M�R�UDRE55 C�T' ZIP P110NE <br />��l�'/C. <br />OENERn�LCONTR�CT011 /MVL�D,O(PESS CIT' ZIV PIx7NE STA7El10EN9E1 <br />N('/R / ��i% /7`f6i/�lf , � __ <br />MECNANICAI CONTR�CTOR M�II AADFCJS CITY ZIP PIqNE ST�TE LICENBE / <br />hi �3 �/v..,l�,:,� <br />PLWBI/qCONTR�CiOR M�IL�DDRE55 GTV 21P VM]qE STRELICENSEI <br />LONTP�GT VPICE OF WOfilc <br />� � � � <br />DESCRIBE VIOM: �NU SIX1�Po <br />ew�on+o <br />LEOAI� D^E-B�CRIPT:ON OF PROPERTY IS1q'NN BELOW OFR �T7ACH iW0 �OPIESI <br />LOTL--� BIOGN OF !� �S'� ��V � <br />i3Rsic, aa <br />:0 NUMBER <br />CONSTRUCTION lWN lENOER. <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />URINAL <br />DRINKIN3 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CN RE�RSETB�CM <br />20 ' Zo <br />USE20NE LOT�RE� <br />�s. Bl w <br />rn� acars� r+o or sronie <br />BL� * <br />SF <br />RF.�SON <br />9Y <br />CONTACT PEP90N �ND PNONE NO <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND OROINANCES OOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />TNOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOFITY TO VIOLATE Oii CANCEL THE PROVISIOP!S OF ANV <br />OTHEF S?ATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT ! AM AUTHOqRED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICA?ION IS MADE AND i COMPLV WITH THE STATE <br />CONTRACTORS LAW 18,27 P.CW AND 296.200 WAC <br />$ �."�7 CJ'/d' � S <br />sx�n�� ���f <br />�' fit�P�K�NF99iKiNNlq <br />UNIT hEATCRS-0. <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATF� <br />WOODSTOVE <br />METAL FIREf`LACE <br />FIREPLACE INSERI <br />EXHAUST <br />SUBTOTAL S <br />PERMIT S —� <br />TOTAL FEE E � <br />13As ic� a� � <br />, SIDFSETB�C� PI�NCNECK UMBER <br />cy�� <br />v�r,�Nr srte FEES <br />YES � NO AUILDING <br />$ Of[IIMMLY IH1 OiGV111MfIIM115 — <br />�"�"'.'i 1 PLUMBING <br />FIPE 8PRINXlERS F:00 <br />—L — <br />FIPE AURM REOD <br />No <br />PlANS�PPROVEf'BY <br />(o/�z�93 <br />D�TF \ �� <br />P�SEMENt � <br />VES I✓NO <br />NEION't LaIMIT�TION <br />L�' <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />MECHRNICAI _ <br />ADDITIONAL PLAN CNECM <br />O7HER <br />STATE BUILDINQ SURCH� RC_ <br />PUBIIC WORHS <br />TOTAL <br />`+UB TOTAL S <br />PERMIT S i <br />_ TOTAL FEE S —�— <br />J �� �/ <br />FEE RECEIP 10 <br />��`l.;- - : � %O�� <br />VALUATION FEE <br />5 � _'� ' _� <br />�/'J i �i . � <br />• <br />i <br />�C <br />i � <br />� ��%� <br />-- — y:='- <br />�r ) i (� <br />/r�/ �I.� <br />