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_- _1 <br />/1PPLICATION FOR CONSTRUCTI ���I <br />�^� F������ TO BE COMPLETED IN INK—PLEASE PRIN f <br />citv o� � <br />everett MaR 4_ �ss, � <br />-- <br />_-- ---- <br />_— --- <br />BUILOWG DEPARTMENT HEATING SVSTEM: ,,�GqS J ELECTqIC .,,J _.,_ _, � <br />— _ .. ......... <br />259-8810 ---- -----�YTj`�p�}�- <br />BIdR. Permit Counter <br />DEMOLITION COMBINATION �(BUILDING MECHANICAI PLUMBING <br />--- <br />qWN(H —__—_—__—___ __ __ . . <br />M�ii �WRF55 � _- GiV — - - - - <br />cr�pNF <br />Ross I.IoL ��b 5£ £.•tcr i� IViAuw+Y $ �{' S -- <br />rrrurrt — Mui�nonrss �..�1e �.i. j� C1b'Zc�� i.r.3��[�.�.o <br />nrr ziv o.�,,..,� <br />AOf.H�1Ff,tOqpESKNER M�II�pDRESS <br />CiTv 21P <br />J <br />_ SIGN <br />.�NER�L CCV"-RILLOP NAII �ODREf.S rifV <br />I�r p�E IICENSE • <br />_^.Rou�,u i+om[S�,�Ne �1"SSL Ev�nl�«�u�Y~�A £���r119t.k.X 353G,'ro e'lK.uSNT/0� <br />M ".f.N4Nlf�l CfMliq�C�Oq ,AAII �DDflk:S GiV <br />z1P P�E LICENSF � - <br />PiU1.IBiN.C(k1tR�C10H MNIAUDRF!i ----- <br />GTV <br />��:/l �S5 0F Yqq1( -- <br />/�. NEW ADDIiION ALTEf�AT10N <br />CONfRAGT �PICE (n WOPN ��p � (X'�O --- <br />f�FSi 1iiBE'NONN �NpSqIUqE LO01/iiE IVVOLVF'0 <br />��'%'�L N w r��u;TKucTio✓ <br />VRUMISE�UCf Of flUI�pING <br />11EPAIR <br />I EG6' DESfpIPTION p� ppOPEf1iV �SNOWN PFI O W OR Al1A( H{ W R C(NIE51 <br />l01 I BlQ'N � <br />_ oi 1��rc. P�nr. <br />Urviy�pN L. <br />�°y J�S�-�' p►, s.[ <br />Pn�:16rJ nUDnffiti .—' <br />n�. TYPE OF FIXTURE ON ITEM <br />�' _ WATFR CLOSET �TJILETI <br />_L BATHIUD ---�-�-- - <br />_ � IAVAiORY �W�SH BASIN) <br />, SNOWFR <br />� KITCHEN SINK 6 DI3P <br />/ DISHWASHFq <br />LAUNORVTRAY <br />/ CLOTHES WASMEH <br />URINAL <br />__ DRINY,INGFOUNTAIN <br />FLGOR DRAIN -- — <br />__ BACKPLOW PREVENTERS <br />_ FOOF DRAINS-RAINLEADERS <br />__ SINK (SERVICE-OAR, ETC.� <br />:IP PHONE LICENSE • . . . <br />DEMOLITION WOC:DSTOVEiFRPI.INSERT <br />C(k1TqCT PERSpry �ND PHONE /p <br />_ ���ivN6�J _3t;'Ll/C7 <br />BUILDIPIO RELOCqTIUN <br />I HEREB� CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TqUF AND CORRECT. ALL <br />PliOVI510NS OF LAWS AND ORDINANCES GOVEHNING THIS TVPE OF <br />WORK WIIL BE COMPLETED WITH WHFTHER SPECIFIED HE7EIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />r1THER STATG OF �_OCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIIED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WpqH FOq WHICN <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRAC?ORS LAW 1827 RCW AND 296200 WAC. <br />SIONrli1111F 0( C<M'tq�CiOR OR At1tMOqIZFL �GENt J�IE <br />X `z�,i��`i i <br />�cQ4,.ilV �C3-�1 nC -1/�— b"Z.. <br />AVV�IG�ryi5611vqp5MlSSlICFNSENOAN09115ME5 �MF�� � � � <br />^�• TYPE UF EOUIPMENT FEE <br />AC-A-HNDLG UNITS-H P <br />FORCEDAIRS`.'STEMS-B.TL ME.A. <br />' UNITHEATERS-B.TU M ��" <br />CLOTHES ORYERS ---T- � <br />�j _ 3 VENTILA710N FAN - � -� <br />y RANGE HOOD --�-- �- <br />i WATER HEATER - <br />�' � WOOD S70VE ��-_- � <br />METAL FIRFpLACE 8 CHIMNEV , �- <br />0 <br />-- _ ._ _ SUB TOTAL $ - <br />-- - --- PEFMIT y -_yl _., -- <br />TOTAL FEE E j�� f��-� <br />FOR UFFICE USE ONLY: <br />FR(N."SFIBRf,K --- RE�RSETBRCk �--_---- -----"---�"-�---- <br />SIOE SETBACk <br />_ � � "_'_ � � � <br />❑SF tnN� 101�RF.� — <br />WC11N1 SRE <br />" �r Sa s .rr <br />�� OILON�151AU0WAB1[ rvrrmcoxsiecruu rca���r+ unnnn�.,«.��M��. <br />� .V . / . . / �Mia <br />v ,✓ 3 <br />tiilE W Bep�G ��� ry0 Oi STpqIE3 p�ccuou� �� ��� <br />/ 1_� '� J� / <br />�N'fUP�qCYLOAD FIRFSPRNMII <br />�� � <br />HE.1�FOq SPROryt�ERS <br />— a . <br />MLHEPV PI�NS <br />T /I <br />� <br />iEQD NFIfiHiIIMRItIfHI <br />� `� <br />,�,=.� <br />fl` � CITY OF EVERETT <br />LOCALSALES <br />�� � TAX CODF IS 3105 <br />HEATPUMP --�- <br />GAS PIPING -- <br />E%HAUSTFAN T <br />, SUB TOTAI. § �� _. <br />-- -_i_- <br />_.__ PERMI7 § <br />TOTAI FEE $ .o„ � -- <br />PLAN (IIFCh <br />�/� J v <br />BUIIDING .._. _ .. <br />Pf.UMAING <br />MECHANICAL <br />AODITIONALPUNCHECN � <br />OiHER <br />STAiF PUu DMG Sl1RCMARGE <br />PIiNI IC WORNS <br />TOTAL <br />�'/.f._i nECFlV�Nr� <br />�Yn7/ �tf63 'Y <br />G/� dL Y__ __`/L F`' Sl) <br />--'_—_— — _ _—_ i �00 <br />- �a � dc <br />--- — - �c HC <br />— — — ---- y � � <br />�o jva <br />