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FROMTEVERETT BUILDING DEPT TO' 2066433475 TFN 171 1992 2:13PM 9412 P.02 <br /> /a-A fe'c�' APPLICATION FOR CONSTRUCTION PERMIT <br /> -To BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: .I GAS U ELECTRIC IJ _- <br /> 259.8810 \ <br /> I I DEMOLITION I I COMBINATION P I BUILDING l J MECHANICAL I PLUMBING I I SIGN <br /> OWNE11 MAIL AODRCRS DAY ZIP PHONE <br /> 1 ZtiF 1 , 4 11O AC IJ-1f Fe , 7 <br /> TFNANT MAR ADDRESS CITY LP r PI104E <br /> APC(ypITFCI 04 DESIDNCR MAIL ADURESS CII Y ZIP r.IOKF <br /> OENLMLCDI TRACTOA MAIL ADORC611 LITY ZIP PHONE 6TATF LICENSC9 <br /> iZI7L_, ej'V, c'l27)Lt-f/. ro!(AV7 <br /> MFCHANIUALJOFIIRACTOR MAIL AUORESS CITY 21P PMONC 61ATC LICCN6F1 <br /> PIUMVINU CL;TT CT(IR MAX AIDRCSS CITY ZIP PHOHC STIIEUCCNVF1 <br /> u65(x WORK <br /> �,T\tNEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WCOOSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> CONZAgT PERSON AND PIIONFN . <br /> C41TRAf•1 NNICE OF WORN / JV Cf ?3G'. C7[� -_),�r U_�{L. (-9L-Grsz.cr./�- <br /> DCSr.RIRFWORKANUSOUARCFOOIACC CAVFD - •' <br /> HNUI'UU[o use Of ouRRIND I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> /� SCC �!l-Y*•u /i /L C',�7GLCl t C ! APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEMLD qN1r4lONnrPAOPFArNY s BELOW:/] TTACRJF,DDR7lE,1G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE Or <br /> LOT ` `7 eLxK / OF !" i.GJ cif �� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO 'VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> •,• 1 C I rh�'S• �! {� �> OTHER STATE JR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF (HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> • APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> -- - h7•CT // <br /> CONTRACTORS LAW 18./27 RCW AND 206.200 WAC. <br /> X <br /> PNOJkI`I ADDRCRR W"IDAF NTF <br /> — — <br /> ✓ pn nnwrAAlx••xs x0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> 1 WATER CLOSET(_TOILET) AIC--AIHNDLG UNITS—I1.P r— <br /> ' BATHTUB / FORCED AIR SYSTEMS-8.1.U. M E.A. <br /> LAVATORY(WASH BASIN) _ _ _ ) _UNIT HEATERS—B.T.U. M <br /> I SHOWER ' _ CLOTHES DRYERS <br /> I KITCHEN SINK 6 DISP _ _ I VENTILATION FAN <br /> I DISHWASHER RANGE HOOD _ _ •�— <br /> / LAUNCRY TRAY ;_ WATER HEATER <br /> CLOTHES WASHER _ T WOOD STOVE <br /> URINAL _ ' METAL FIREPLACE S CHIMNEY �— <br /> C'RINKIN_G FOUNTAIN _ FIREPLACE_INSERT ' <br /> FLOOR GRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS ) GAS PIPING ' <br /> _ ROOF DRAINS­RAINLEADERB I I; EXHAUST FAN —� <br /> SINK(SERVICE—BAR,ETC.) <br /> _. I <br /> I � <br /> I <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S _ PERMIT S <br /> TOTALFEE S ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: /1 C"Lr C c <br /> •RONT SrIAAOK RCAR RSTRACX I SIDE 96TSACK I PLANCII CKNIIMDFR PCC RECkIP1 N0. <br /> JSk ERNE LD•Ankh VACANI SRE FEES VALUATION FEE <br /> _ 13 99 7 / BUILDING <br /> rrEOl-ON3 MIOWMILI ITPc DICONST.ACTOAL OCCWxn xR dPNTIPNS UNIit -• may--! ^ - <br /> _.. PLUMBING <br /> iqC 15, NORTORffAS <br /> 6 DCMGNT <br /> •33 S ! SF .Or MFCIIANICAL <br /> 7Z.G• SP 4nR J 1v OL[ _ .I.- I <br /> CUPANCYLOAO rIRC 6PRNKI FRG REDID HEKHITLIMITATION ADDITIONAL PLAN CIICCK <br /> Y•- J j <br /> �kAGONFDRGrRI4KIFR6 A/D 7,1 SPRINKLER 47� - 1G '_ __ <br /> STATE BUILDING SURCHARGE L <br /> rtAKE BY mWa APPROVFO BY CITY OF EVERETT PUBLIC wORKS <br /> J LJ LOCAL SALES <br /> TAX CODE IS 3105 TOTAL 3 I - <br />