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1 <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />_ ___ - _ - — -- -- � <br />� HEATING SYSTEM: ,QGAS J EL[CTRIC J______ _ _ J <br />BUILDING DEPARTMENT — — -- <br />259-8810 <br />DEMOLITION COMBINATION /�UILDING i11IlECHANICAL �-PLUMBING SIGN <br />pWNER A1411�00�iE55 CIIY Ii�' PIIONF. <br />/%j�rics,,v � STALz� �✓�� t� 95�y�v 3 3�-3i9Y <br />trNU1r MnRnr�oPrES Grr ilr rHONF. <br />�i �/ �/ i! <br />ARCurtfGTOqDESIfNCR MnRPppRE55 CITVI� IIP // PMONE <br />AA► Eri �.I�C��T¢�'ES <br />GpRRRICONiRACTOH M�RnpDRESS GiY IIP PMpNE STR1EtIGENSE• <br />/ / �! �/ �� <br />MEL�UNiC4lCONTR�GiOR MAi�A00RE55 GTV IIP PMONE STATELICENEE• <br />/� �( / �� <br />ni UI,IAING COA iR�CiOR MNl �OORFSS CITV 21P PHONE STATE IICENSE I <br />�� // /i �r <br />['.USSOF WOtiF <br />�1QE'N ADUITION ALTERATION FEPAIR I�EMOLiTiON WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />_ LOhiqCT Pj1150N �ND PHONf 1!O <br />CONiR�CTPf110EOGWUAM �/(/VCJ <br />(1ESCRIOF N'ONN RND SOVMF FfTli�fif iNVOIVED <br />/ — _i+�� — � ��� � <br />vnorosEo usE or eun.oir+c <br />s/sY �Pc � <br />IEf.AL UESCR 'ilON�iSNqYM AEIOW ON ATiqCN F W R COPiESi <br />�or� o�a. �� SP���z•3-9� <br />Tr.9� i '`�� � /°�9?� �G- f�� =2. <br />sit�AG�I`_S,�v�✓ GY , <br />-33— ���-'s� 5� <br />P(IOJECT p�DFEOS <br />Q, WA?ER CLOSET (TOILET) <br />I BATHTUB <br />LAVATORV�WASH BASIN� <br />SHOWER <br />L HITCHf:N SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY _ <br />/ CLOTHES WASHEIi <br />FOOF DRAINS—RAINL <br />SIWK (SERVICE—BAR, <br />FEE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ �~' <br />FOR OFFICE USE ONLY: <br />iRONi S[IDACN/ NERR SETBAc�f � SillE SF.TBACN / <br />� L�' s <br />USE IONE LOi ARFA VdG�NT SIIE <br />tvf'( U� C01115 I�nW�Blt IYCE Of LONSI IClUAL a�:u�•�a� x0 amvW •v��.5�'S <br />— '��i 'ani�_'_ � _ <br />"iZ[ Of HI'T NO Uf St(Ni:ES B<SEWFN` <br />138� 5� �"... i ,Uo <br />vinE <br />PF ASON F09 SPRIfIXtERS <br />11EI(IHT IJ I* KM� <br />�NIAMF BV P14Nti �PI'ROVf `PV CITY OF EVERETT <br />� LOCRL SALES <br />J� 1 5•i3 T^•x CODE IS 3105 <br />-`- <br />i HEfiEBY C[RTIFV TNAT I HAVE READ AND E%AMINED �fHIS <br />APPLICATION AND HNOW THE SAME TO BE TRUC- AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOFH WILL BE CU�.IPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GHANTIPICi OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORIiY TO VIO�ATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OF IOCAI. LAW FEGULATII<G CONSTRUCTION OR THE <br />PENFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAD[ AND I COMPLY W'TH ThIE STATE <br />CONTRACTOR3 LAW 1827 RCW AND 296.200 WAC. <br />x �� <br />1 �� �� - /� " %�. <br />. .p'�unr n�n <br />L� <br />N0. <br />A�C--A'HNDLG UNI7S—H.P. <br />kORCEDAIRSI'STEMS—B.T.0 M E.A. <br />UNITHEATEPS--B.TU. �vl <br />CLOiHES OPYEFS <br />VENTILATIO�� FAN <br />METALFIRePL <br />fIREPLAC�IN <br />HEAT PUAIF' <br />GAS PIPIN6 <br />EXHAIIST FAN <br />r;a:a-+ c.� � <br />P� nN CHF Ck NI IF'Pf H <br />J���i 7C" <br />__ , <br />FEES <br />BUII DING _ _ — <br />PIUM[31NG _ <br />M[CHANICAI. <br />ADDITIONAL PLAN CNFCN <br />-�c�,r- � 'n t�. <br />R <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 8 <br />U <br />fEE <br />3a 7• 9. � <br />STNE BJ I.OING SURCHARGE <br />PIIf31JC YIORN$ <br />retn� <br />