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.., _ <br /> APPLICATIO.� FOR CONSTRUCT►.l�N PERMIT everett <br /> �n,E,�,�,,,,, TO BE COMPLETED IN Ii1K—PLEASE PRINT � <br /> CITV OF �A I a� <br /> everett ^-° <br /> BUILOING DEPARTMENT HEATING SYSTEM: ❑GA: ❑ELEC i RIC U <br /> 259 9810 <br /> DEMOLITION COMBINATION �BUILDI�►�IG_ MECHANIC4L �PLUMBING SIGN <br /> ownen u�n �onaess �7J� �CyI� zm rNoae <br /> �wIE__ �./�,cl�lein�l E�EeEt1 48� 353- 77b9 <br /> TEN�NT MAIIADDRE55 GiY 21P PHONE <br /> �RCNRECT 011 DESIONEN M�IL�0 RE55 CITV 21P PHONE <br /> nr�A <br /> OENER�LCONiq�CiOR M�RADURESS CITY 21P PIqNE LICENFSa <br /> OWNEQ <br /> MECH�NICN CANiRAGTOR M�II AO RE55 CITY TIP PNONE LICENSE� <br /> u�A <br /> PWMBINOfANTR�CTOP M�ILA��RESS f.ITY iIP PHONE LICENSE• <br /> �WNU` <br /> C SOF WqIK <br /> ' � NEW � ��. ADDITION . ALTERATION REPAIR DEMUUTION �. V/OODSTOVFJFRPL INSERT ' I BUILOINO RELOCATION <br /> GONTR�CTPRICEOFW011K A�!'r!—" (�.3(/ eltii I� 1���1 CONiACTVER �NOP�NO � � _ �� <br /> DE IBF�'IOHR AND SqURE FOOT�OE INVOIVED <br /> .Z(a Y J�� C - 71�� G�� <br /> rroroseous OFBUIlDIN6 1 HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> !� APPLICATIOiJ AND KNOW THE SAME TO FE TRUE AIID CORRECL ALl <br /> tE0A1 DE9CRIPTION OF PROPERTY�SMOVM BELOW OR�TT�CM iWR COPIES� PROVISIONS OF LAWS AND OP.DINANCES OOVERNIr10 THIS TYPE OF <br /> WORK WILL BE COMPLcTED WITH WHETIIEH SPF.�IFIED HEREIN OR <br /> �oT eiocK or NOT. THE GRANTIN6 OF A PEFMIT OOES N(`i PRESUME TO (31VE <br /> AUTHORITV TO YIOLATE OF CANCEL Th'E PROVISIONS OF ANV � <br /> OTHER STAiE OR LOCAL LAW REOULATING CONSTRU.TION OR THE . <br /> — PERFORMANCE OF CONS7RUCTION, THAT I AM AUTHORIZED BV THE <br /> OWNER OF TH�S PPOPERTV TO PERFORM THE WORK FOR WHICH � <br /> APPLICATION IS AtAOE ANO I COMPLY WITH THE STATE <br /> CONTRACTOHS LAW 18.27 RC�N AND 296.200 WAC. <br /> SIMUTUREOFCONTRACiONOP�UTH081ZED�6ENT DATE <br /> X (y/y'� ` <br /> PRQIECT�DDRE65 � / — ��,t <br /> O P SG �PP���NTS YBUSINESSIICENSENJ�NOBUSINl55N�ME <br /> PLUMB Nfi MFCHANICAL <br /> NO. TYPE OF FIXTUHE OR ITEM FEE N0. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � — A/�NHNOL6 UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS--B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) — UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRV TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOU STOVE � <br /> URINAL METAL FIREPLACE 6 CHIMNEV <br /> DRINKING FOUNTAIN � :IREPLACE INSERT <br /> T <br /> FLOOR ORAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; 6AS PIPING ; <br /> ROOF DRAINS—RAINLEAf1ER5 E%HAUST FAN <br /> SINK(SEHVICE—BAR,ETC.) <br /> _� /O� � <br /> — � — <br /> SUB TOTAL S — SUB TOTAL S <br /> PERMIT S r PERMIT S � <br /> TOTALFEE S — TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FNONT SET� � f1EAR SETBA;N b10E SET011C; PI�N�'C�1t NU�E/ FEE 3�p RF J�� /��S <br /> �p /3 <br /> USEZONE LOT�RE� VACIUITbITE FEES VAIUATION FEE <br /> " ti �� ���� �� BUILDING <br /> IYPFO/CON75 AIlOW�81F 1VPFOf WN51�LN�I orcuwrn rq d uiMGUNn1 <br /> 0R°j° PIUMHING ; O'[� <br /> T <br /> BRE OF Bl(K3 NO OF tlTOR1E5 BASEMENT MECHRNICAL <br /> 8� $ J � <br /> OCGU?ANCY O�0 FIRE BPRNKLERS REO'0 NEIOMT LIMR�iION ADDITIONAL PLAN CHECK i <br /> �/p /s � OTHER <br /> � <br /> RE�SON ORSPPINICLEFS � <br /> STATE BUILDINO Sl'RCH�q�E �rV <br /> INi�NE Bv PLANS�PPROVED flY CiTY 0F EVERE7T PUBIIC WORKS <br /> .�/ LOCAL SALES <br /> N g��s TAl(CODE IS 3105 TOTAL ���,5� <br />