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APPLICATIC'�1 FOR CONSTRUCT'7N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SVSTEM: kf GAS IJ ELEC7RIC ❑. —� <br />259 8810 <br />CI DEMOLITION I I COMBINA7iON QG BUIV �NG �QMECHANICAL �74'PLUMBING I I SIGN <br />ONTIE�R M�LLADDqE55 CITY IIV pNpryp <br />/.��.� //�� �s .z�� z � ��o - �i �'`.�v� �_r. �r�c+�o.i�s.� �6�2 yO 3 jv�IS� Z <br />fiNiWT Ii�R�Dp1E55 CIIY IIP P110Nf: <br />AOORE55 Cli� 7�P VNONf <br />�II� El/CQG1� !�� i 2. <br />•DDNESS GpY 21P V110N[ <br />�c� _id.�,-�—.A� ��vr,c� _ -- <br />•ODflESfi GiII� [p• MHUNP <br />riYi i/� /QI�/ L�T//�fi! 7� ai ��� �� <br />GONTR�CT PRICE Of WORN <br />DE9CRIB,fyW011N11NU80U�REF N1VOlVEU � <br />j'�yj,Q.u�s ��liuTiNc _ <br />� <br />%/G %1%,G <br />SiATBIICENSE / <br />SIIUE IICf.NSE � <br />CIIY lIV PINN1k � ST�dE IILENSE / <br />�n�� 3.�5-LOi9 1�g-ozc�,�r-r��� <br />� V <br />' PAOPERIY �SIWVJN BEIOW OR ��IACN iW0 GUPIF.S� <br />e�ocK — ar �f�[��C �✓2i <br />PMCEL T�%I D NUMBER <br />8/7s -oov -D/y -Do�b <br />CONS7Rl1CT10N /OAN IENDEp, �DDqE84. TEIEPHONE NIIMBEP <br />PROJ£CT ADORESS 'C� `�' <br />c��0� .3 /�/ b � cY� <br />PLUMBINU <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILEi) <br />Z BATHTUB .,� �i� <br />LAVATORV�WASH BASIN! <br />SHOWER <br />HITCHEN SINK 8 D SP _ <br />DISHWASHER <br />LAUNORYTRAV <br />CIOTNES WASHER <br />UHINAL <br />_ DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />EACKFLOW PREVf'�TERS <br />ROOF DqAINS-RAINLEADERS <br />SINK ISERVICE-BAR, dTC.I <br />FOR OFfICE USE ONLY: <br />F11p:TSETBACY� PE�R: <br />U6E ZON� Ll1T M <br />.e.-- ;" � <br />REASpI <br />SUB TOTAL S <br />PEflM1T S <br />70TAL FEE S <br />� <br />FIRE BP011MLEXA PEO'0 <br />� <br />FMEILLARGREOV <br />n,�• <br />PlANS�P R oer <br />�� <br />oae A//i�I� <br />CONUCI PkPSON �r.,; PIN]IIE lID <br />�9ti�u.✓ .�3`�-�/5 `G�'L <br />i HEREBV CERTiFV TF'sT I HAVE READ AND E%AMINED THIS <br />APPLICATION ANC KNOW THE SANE TO PE TRUE AND COflRECL ALL <br />PROVISIONS OF l 4WS AND ORDINANCFS GOVERNIN6 fHIS TYPE OF <br />WORN WILL BE C)MPLETED WITH WHETHEH SPECIFIEC HEFlE1N OH <br />NOT. THE GRAN7 iNG OF A PERMIT DOES NOT PHESUME TO QIVE <br />AUTHORITV TO /IOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE UR LOCAL LAW REGI ILATING CONSTRUCTION OH THE <br />PERfORMANCE OF CONSiNUCTION. T4AT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERF�RM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 CC�MPLY WITM THE STATE <br />COf�J . CT R LAWt� 1jj�CW A 0 296,�jQp� fC. <br />,.',��� !'/.t/frl�M .�r , <br />_1�Z����.s� `7 ��S <br />ILIF <br />N0. TYPE OF EOUIPMENT --FEE 1 _ <br />� NG �NHN�I.G UNITS-H.P. <br />' � FORCEO Alq SYSTEMS-B.T.U. M E.A. <br />r UNITHEATERS-A.TU. M ' <br />CLOTMES ORYERS �— <br />VENTILATION FAN <br />RANGEHOOD T— <br />' WATEH HEATEF <br />WOOD STOVE <br />METAIFIREPIACE�W00D8UANINO) � <br />FIREPLACE INSERT ; <br />HEAT PUMP <br />GAS PIPING ' <br />EXHAUSTFAN �— <br />� J. . <br />SIDESEiBACN PL�NCIIFLNNUMOkfl <br />S' z �3�0 <br />v�cu�r sne FEES <br />I i VES I l NO BUILOING <br />IY(YNM:Y 4U 01 IIIM�INIIS <br />d'"� aLUMflING <br />�-. <br />B/SF.M[r+T MEGIANIC�L <br />I I VES �O ------ ---- - <br />MEIaN1lIMIUTION/ AODITIUNALPUNCHEC' <br />� O1MEH <br />STATE BUIlDIN6 SURCHAROE <br />CITY OF EVERETT p�ly�IC WORKS <br />LOCALSALES <br />TAII CODE IS 3105 rore� <br />_SUB TOTAL f <br />PERMIT f <br />TOTAI FEE { <br />� t )�. i �'.� <br />3/ /� IIECEipJ�/�` <br />O J <br />� �i <br />