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•APPLICATIOh FOR CONSTRUCTivN PERMIT everett <br />� e <br />rne e.e,p,aen TO BE COMPLETFD IN INK—PLEASE PRINT <br />CITV OF <br />everett HEATING SYSTEM: 6d GAS O ELECTRIC 60 Ner tuo�_f/fY�%. <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOUTION �'COM8INATION �( BUILDING <br />OWNER M�q �DDPE55 CITv <br />tJicc�A.N � 6�e��rz� � o� � Gc.✓� Er/t�x <br />TEN�NT MMI. AUOPESS �i7y <br />�RCNITEGT711DFS�ONER M�IUDORE55 CITY <br />GENEPLLCONTR�CTOR MAILAUDRE55 CITY <br />(��i�_t�Fn•c �• (r•c�,L OO•Box G(oo. fvcYfT <br />MEGi�hNICAICONiR�CTON M�R�DDRESS CITY <br />PWMBINOCONTR�CTOR M�Il�00RE�`� pry <br />ClAS,:OF WqIN <br />MECHANICAL <br />21P PMONE <br />�-u4 . � �zo c <br />ZIP PHONF <br />IIP PHONE <br />21P PMONE <br />,vA• /�Zpb a <br />ZIP PIqNE <br />21P P1qN! <br />PLUMBING <br />IICENSE • <br />SIGN <br />��:' NEiY � ADDITION . ALTERATION � REPAIR � DEMOLITION WOODSTOV6FRPL INSERT x BUILDING RELOCATION <br />����"' //J y� CONT�GTPERSON�NOP110NEN0 <br />CONiR�Ci PRKE OF WORK / 62 � f.� � 3 r33 d4y : i.sit' • <br />DESGPIBE VqRlt .�N� SOU�RE FOOTAOF INVOLVEJ <br />/ronar iheve fit+,., iii9- /LYksi. �S�' %�1� /'�°�HP. <br />vno seovseaaunowa �J I HEREBV CERTIFY THAT I HAVE READ AND EXA�!�NEO THIS <br />/ %�'�?�//L /�C���IC • APPLICATION AND KNOW THE SAME TO BE TRUE ANG � CRRECT. ALL <br />LEOQDESCPIVTIONOFPROPlAiV15 WNBELOWOR�TTACNFWRfAPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINOTHI51"PEOF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIE� HEREIN OR <br />�°T� �°�K -- °F NOT THE ORANT N6 <br />PROIECTADDRESS <br />�/3 � — //G � �— <br />PLUMBINO <br />KITCHEN SINK 6 DI�P <br />DISHWASHER <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOIINTAIN <br />DRAINS—RAINLEA�ERS <br />FOR OFFICE USE QNLY: <br />FRONi5Ei8�GK qEAq SE7BACN <br />/ �7 sY <br />�" <br />USE 20NE lOT �RE� <br />(�- r � <br />h'M Of �ONiS /IIOWABIF fYP[ pf Si �CIUII <br />SIZE pf BLo� NO OF SiORIES <br />/6Ys S/ � / <br />CfLUPN/CYIO�L iIRESPRNNlERSRE <br />_ NJ <br />er <br />PUNS �PPPOVE� BY <br />FEE <br />I OF A PEfiM1T DOES NOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />O?HEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMAtICE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER GF TNIS PROPERTV TO PERFORM THE W09K FOR WHICH <br />APPLICATION IS MADE AND I GOMPLV WITN THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />SION�7UREOFCONTRIGiOROR�U7HOqIZE�AOENT D�TE ����/�/ <br />��.�'r�.z, � .�.v.o <br />PLICANiS CIl/ BUSINE55l�5E NO ANO BUSME55 NAME <br />MECHANICAL <br />NO. TYPE OFEOUIPMENT FEE <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER ^ <br />WOODSTOVE <br />METAL FIHEPUCE 8 CHIMNEV <br />FIREPLACE INSEqT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUS?FAN <br />S�f1E SETBAFN PI�N CHEC"t NUMBER <br />s i/ �G � � <br />MC�NT SITE FEES <br />a���o�N� a s r• s� .�, <br />OLCUMNC�� NOdOWlII�MGiM��6 <br />aa3 r PLUMBINO <br />B�SEMENT MBCHANICRL <br />�D N[iGNTi�Mir�r�orl ADDITIONALPIANCHECK <br />/ <br />O7HEH <br />STATE BUILJING SUNCHAR�E <br />CITY OF EVERETT Pl1BLIC WORKS <br />LOCAL SALES <br />6�� TAX COOE IS 3105 TOTAL <br />M E.A. <br />SUB TOTAL S <br />PERMIT S _ <br />TOTALFEE f <br />Y a3 <br />FFF. RECEIPTNO <br />� Yy� f.� v 96 � o <br />,� <br />0 <br />