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APPLICATIO.�; FAR CONSTRUCTI �N PERMIT ��� <br />TO BE COMPLETED IN F3LACK INK—PLEASc PRINT <br />BUILDING DEPARTMEN i HEATING SYSTEM: ❑ GAS J ELECTRIC U__ ____ __ ___ ___ _� <br />25b-8810 <br />JEMOLITION COMBINATION \\'BUILDING MECHANICAL PLUMBING SIGN <br />t1WNER M�R�UORE55 �TV In. ----. o��Up� <br />(�aVEMaeR PA/�I�_R�lf1�_aa�oa -`6 n, qvE. Wtsr M�.��/U� -��.Rn�L („�A•9BoY3 '775.5'�t� <br />TE4�N7 MbI�DORE55 GIiV IIP PHONE <br />ANCN�iECTORPE51GNE11 MAl�00RE55 <br />GEHkH�L LONTR�CTOR MA1l <br />� <br />Cliv ZIP PHON� <br />PNONE STAiEIICENSE/ <br />MECH�NICQCONTRAGTOP �i1�L�DOR[Sti ('rtV lE� Jiv {•HONE gt�TEIICENSF�IJ <br />- —�y�� _ 99't-�891 D�6�rA� PR�R <br />VIUMflINGCONiP�GTOR M��IAUCRl.55 Ci1V Iin PIIONE ST�TF.IICENS[� <br />GL'SSOFWORN �--� -- - <br />�EN� ADDITION _ ALTEFlATION REPAIR DEMOLITION WOODSTOVErFRPL INSERT BUILDING RELOCATION <br />^ LLv'pC I P[RSON AND PHONE Nq '7 <br />• CONiR�CTGRICEOFWORM� �y 1 QOQr �— �� �p�(�� —'�"�S'S�Y / <br />rt <br />DESCRiAE WORk �ND SOl4PE :001�f E INVOLVEO <br />PqOPOSpp p$E p� BUII�ING <br />IF.aAI��� RIP7101 Of PqOPERfV <br />LOT 9lpCl� <br />PNOJFCl�DDRE55 <br />�C�7 � (.a..� <br />TYPE OF <br />WATER CLOSET <br />BA7HTU8 <br />LAVATORV (WASI <br />SHOWER <br />KI7CHEN SINK 8 <br />1715HWASHER <br />LAUNDRVTRAV <br />CIOTHES WASHF <br />URINAL <br />i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICAiION AND KNOW THE SAME TO BE TqUE AND CORRECT ALL <br />LOWORQUCMFWRCOPIE6� PqOVISIONS OF LAWS ANU ORDINANCES GOVERNING THIS TVPE OF <br />WOHK WILL BF COM°LETED WI7H WHETHER SPECIFIED HFFEIN OR <br />� NOT. THE GRANTING OF A PE�,?d1T DOES NOT PFESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER S?ATE OR LOCAL LAW REGULATING CONSTRUCTICIN OR THE <br />PERFOFMANCE OF CONSTfiUCTION. THAT I AM AUTHORIZEU BV THE <br />OWNER OF THIS ^FOP�RTV TO PE FORM THE WOFH FOR WHICH <br />APPL ATION IS MAfiE A COMPLV WITH THE STATE <br />COI�AC�ORS LAW a827 RC A D 296200 WAC <br />� � <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEADERS <br />SINH (SERVICE—BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />FRONT9EiB�CM REIRSFTPRf,N <br />lO7�RE� <br />FEE <br />SUB TOTAL S <br />PERMIi $ <br />i�OTAL FFE $ <br />SlfiE SFiBACN P�. <br />VAC�NT SITE <br />�YPEOlCONIS �lIOMABLE lYPEOftON51 ALTIUI <br />5RE OF BLOG NO OF 5T081Efi <br />OLC9PNICY 10�0 FIRc SPRNNlERS PE7p <br />RE�SON FOR SPRINNlF.RS <br />iNt�rcEAY P�ANS�PPROVE�BY <br />'� s M <br />6 <br />NO. TYPE OF EOUIFAIEk <br />A-C—A�HNDLG UNITS— H � <br />FORCED AIR SYSTEMS—E�1.U. <br />UNIT HEATERS—B.T.U, M <br />CLOTHES �qVERS <br />VENTILATION FAN <br />RANGF HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEV <br />F�R@PLACE W�ER7 <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />BUILDING <br />acn�o.a� rwawvnuwur�ns �-- — <br />�pMv pILMBING <br />BASEMENi MECHANICAL <br />NEI6Hi llMlt�ti[N� ADOITIONAI PLAH CHECK <br />--_ ___ SPRINNLER <br />STATF. BWl01NG SURCHARIif <br />CITY OF EVERETT rueuc wor�ks <br />LOCALSALES <br />TAX CODE IS 3105 ror�� <br />�'16-9a <br />r�n ---' <br />FEE <br />E.A. —_ _-- . <br />� —� -- <br />$ <br />$ <br />S <br />R! f.F �PL NO <br />"' i ; "�' , <br />