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APPLICATIO' � FOR CONSTRUCTI 'N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT aqb�'n <br />HFATING SYSTEM. GAS J ELECTRIC J <br />- <br />BUILDING DEPARTMENT - --- --- --- - _- --__ _ __ __ I <br />2Ci9-8810 <br />DEMOLITION C(�MBINA'��C�;��I�D�l�i��`' Al€C�FjANIQA,� a;�,�y"�LUMBING SIGN <br />OWNER �AnitnDPAISti t.i�v '�— — 7m PHONE ---- --� - - � <br />�au�n� oEr, .ri s/��'� .S E, 1�r�C�� r__ ��Zc}�__ <br />TENONt M�R�ODAF55 fn� /iP P�E � <br />RRCHIiECiOR0E5iGNER MMIb.ORE55 ❑�v TiP PHONE ,-' �f,����.� <br />OENEN�LCONiR�CipB M/XMUIIESS GTY tlP PHONE A I.EN.fi������— <br />� I �;1 <br />MECN�NICALCONTR�CIOF M�II��ORF55 (:ilv zIP PIqryE �- ri �u �bsE • <br />��c�c€���—���,�5 �{�_A'ccP' F�-�-1I�`�'�'�1'�ZS3'_�_9.2 YRLLENGC15�iPM <br />IUMBINaCONiRACLOR M��1110[�RE55 c.nr r�� vHone ��,�-�^fi�uHNY1'+' , :, i <br />— � — a��..�__. __. ._._ <br />CONiR� RiCE OF WpRN <br />��t-S� <br />DESCRIBE W�.�nNANpSW�REFOOT�OEINVO�VE� <br />PROPoSED USE OF <br />LE�MDE9CR�PTpNOFPRpPER1V�SNOWNBEIOWOR�i1ACH�WCCbPIES� � � <br />LOf— BLIX:N --- OF ' �'�� <br />� , � .' <br />PARCELT�%ID NUMBER <br />:/ 1 <br />cONSTRUCTqNLO�NLENDEO ��DPESS TELEPNONE NUA1BrP <br />uh <br />TVPE OF FIXTUHE OR ITEM <br />WATER CLOSET �TOILET� <br />BATHTUB __ <br />LAVATORV IWASH BASINI <br />DISHWASHER <br />LAUNDRVT.RAY <br />CLOTHES WASHER <br />URINAL <br />DRINNING FOUNTqI <br />FLOOR DRRIN <br />ROOF DRAINS-RAINLEADERS <br />SINK �SEFVICE-BAR. ETC.1 <br />FOR OFFICE USE ONLY: <br />LRONiSEfBR1:N �RERRSEIB�CN <br />USE 20NE <br />rrvE a coxsi <br />SIZE OF BlD6 <br />OCCUP�V lWD <br />RF.�SqI <br />O�i�NE PY <br />IOi�RE� <br />NO OF BTORIES <br />FIRE SPRIIMLENS REQD <br />�IRE �LNPM RE00 <br />VlANS�PPRUVFDA�� <br />DFic <br />CONUCT PEPSON AND PHONE Np <br />, ,�� <br />M1�.� ���.� � ��� � I!�� <br />��il '�1 I I ' n/1,', � <br />I HEREBV CER7IFV THAT I HAVE READ AND EJ(AMINED THIS <br />APPLICATION AND KNOW THE SAME TO f7E TRUE AND CORNECT. ALL <br />PPOVISIONS OF LA,'J�S AND OFDINANC�ES �OVERMING, TrjIS TVP� OF <br />WORK WILI BE COMPLETED WI?H WHETHEF; SPECIFIFD'HEFCIN OR <br />NOT. THE,G,RANTING OF.A PERMIT QQE�S,NOT PRF�SIJM�,T� GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THF PROVISIONS OP �NV <br />OTHE9 STATE OR LOCAL LAW R@GULATING GONSTRUCTIONIGIR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM 4UTHOqIZED BV THE <br />OWNER OF THIS PROPER�fV?O�OPFiddNM+fViE�WORI��OHFl WHICH <br />APP,UCATION IS M1�D�CWNANb2g5 ppyyq W�TH;Tf�E �STATE <br />CONTRACTORS LAW 18 7�' � <br />X '�sf>l ��—'_ � �.� -%� _ <br />��l To��4L t, — <br />N0. ���� � 7VPE OF EOUIPMENT FEE <br />A C A hINDLG UNITS-H.P. �- <br />� �btiCEDAIRSVSTEMS-BTU�M f A_ <br />UNIT HEATF.RS -B T.U. M <br />_ � <br />CIOTHES DRVFRS � <br />" ' ' V�k�I�ATION f�AN--- � � - --L-. <br />RANGfi NOOD �-�-- <br />-�.__ � _.. . - - ---'--- <br />/ WATER HEATEF . <br />fIREPLACEtNSERT ; <br />--r _... <br />HEATF'UMP <br />_ � <br />�AS pIP�NG <br />XHAUST FAN - �_—T- <br />--- r- <br />SUB TOTAI S �� <br />PERMIT _$ � � <br />. TOTALFEE S �� � <br />SIDE SE IBRf,N � PUN U�H'r <br />VAL�Nt SrtE FEES <br />VES NO BUIl01NG <br />M<I!v�M�r 4^ M;!hk'.�WnN^• <br />°°�""' PLUMBWG <br />B�SE �ENr MECHANIC�L <br />VES NO - <br />r�icHT uMrtaior� ADDITIONAL PUN CHECK <br />__ __ OTHER <br />� STntE BUIl01NG SURCHAROE <br />CITY OF EVERETT PUBIJC WORN$ <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />�EE <br />�Nl <br />0 <br />