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FROM:EVERETT BUILDING DEPT TO: 2066433475 JAN �, 1992 2: L3PM 11412 P,02 <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> Ta', <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> :ticc� `� <br /> 8mr Occ�-CA-(O-Cc , _ <br /> BUILDING DEPARTMENT HEATING SYSTEM:D7GAS U ELECTRIC IJ— <br /> 25' 3010 <br /> I I DEMOLITION I I COMBINATION BUILDINC 11 MECHANICAL I I PLUMBING I SIGN <br /> OWN7EN L/ARAODRCSS cm tiP PHONt <br /> o»y ontsi; <br /> fiNlNi MAI ADnl GS LITY Zip RNCWE <br /> •ARCHITrcl ON Ut310N[0 MAL AOUNl93 Ch1• 2l1 fIInNF <br /> D!N nq CONTRACTOR MAIL ADDRCii CITY ZD RHO BTATF I,ICCH3Ct <br /> nti0m rzS mJne✓ (ouVTsa�o� <br /> UkANI <br /> MCA1 Cp1MACTOR MAX AUURlSS CITY " 21R rxONc <br /> iIAT!LICCHbF.i <br /> RUMUWOCONTRACt(M HA0.AUDRCU3 CITY ZD' MMONC 71— <br /> N$Fi — <br /> C1 A 9 3 O�WORK - <br /> VNEW I I ADDITION I I ALTERATION I I REPAIR 11 DEMOLITION 11 WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> !1'1 CDNTRFgiON ANO rxouF�{p, '-��- <br /> CgVTRAf•1 RNICC U/WOnK I \1 . •,�: x.303 <br /> _ L ath ice/ J <br /> DCSCRIOF W(1/R/K•]/AN�U,5UUARC IpOTAdC IMJp YFU _ <br /> 6d�nv 15f72 C=V=/1?-r 2]/ef -t7{,. <br /> rxurOutDUSE aDllnnlNn ZT— I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> H'�•� LLGK[(. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> ADAL U CIIlr1.UN of RROPFRTV OWN BELOW Un ATr%CWFOUR COPI"I PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> .OT-4c0-, BLOCK a WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO l IVE <br /> •-1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF I NY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORIC FOR WHICH <br /> APPLICATION IS t� CONTRACTORS LAW 1,8.27 R W AND 86.200 WAC.ADE AND I COMPLY WITH 7 HE STATE <br /> q37 D n <br /> �IC " 137 x r —14 1 F) Ing3 <br /> �C11tL'1 ADDRCiK 7 r,l <br /> �'� FMMIIMi p�Ha NT! <br /> ?SLI S <br /> GIT KLLINPMIN:IN< N0. �- <br /> PLUMBING MECHANICAL <br /> N_0. I TYPE OF FIXTURE OR ITEM FEE NO. I TYPE OF EQUIPMENT FEE <br /> 3 WATER CLOSET(TOILET) - I AIC-AMNDLG UNITS-H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. I <br /> if <br /> LAVATORY(WASH BASIN <br /> AA <br /> a5. ) _ I UNITfiEATERS-B.T�U. M <br /> SHOWER ' CLOTHES DRYERS '— <br /> KITCHEN SINK d DISP __ VENTILATION FAN <br /> _ DISHWASHER I ) RANGE HOOD _ �T— <br /> LAUNDRYTRAY _ I_ 1 WATER HEATER <br /> 1 CLOTHES WASHER - WOOD STOVE <br /> T URINKI. _ ' METAL FIREPLACE d CHIMNEY <br /> DRINKING FOUNTAIN ' FIREPLACE INSERT I <br /> FLOOR DRAIN '" ' <br /> _ ' HEATPUMP <br /> BACKFLOW PREVENTERS I GAS PIPING ' <br /> RODE DRAINS-RAINLEAOERS I _,� EXHAUST FAN '—*— <br /> SINK(SERVICE-BAR,ETC.) I <br /> I <br /> SUBTOTAL S ; _ SUBTOTAL S. <br /> _. PERMIT $ _ i PERMIT S �— <br /> TOTAL FEE $ ' TOTAL FEE E I <br /> R OFFICE USE ONLY: <br /> IT SPiRACK_ / SCAR SGTRICX SIOC GCTDAUK rwicilcCK NIIMSSR ItC RE CkIrI IID. <br /> 7• ,� o <br /> CLWB IB)LI AntA <br /> VACANT ane <br /> FEES VALUATION FES_ <br /> Z <br /> CCKIOA'AIL! 1R(Df CIfx31.ACil11l oCCNusr mpnwnlnLVMIiG Ol11LDIN0 <br /> ]Iq.u !3 <br /> X_X_ -Y-AL -AJ - / PLUMBING •• / / j1 <br /> C7 7Sf Y ND.fF,KTORW3 nGSEMLNT <br /> MF.CIIANICAL l J 1 <br /> 6535 Slf CiQ1 <br /> PANG AO rIRCEPANKIFgb REOL HEKtxtuMITATIOy ADDITIONAL PLAN CHEC <br /> K <br /> —r <br /> JN 10n rRWKl FR6 / SFRIrDM7 — <br /> STATE BUILDING SURCHARGE <br /> :ar r�iilsgPRgovcOer 'CITY OFEVERETT PUBUCWORKS ' <br /> 'OCAL SALES I <br /> 30 3 TAX CODE IS 3105 TfITAL <br />