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FROMTEVERETT BUILDING DEPT TO: 2000433475 TAN 17, 1992 2:13PM 91412 P.02 <br /> � « APPLICATION FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �r <br /> BUILDING DEPARTMENT HEATING SYSTENI: GAS J EI-ECTRIC J— <br /> 259.8810 -- <br /> I I DEMOLITION I I COMBINATION V13UILDING I IMECHANICAL IpLUMBING I I SIGN <br /> ORNEN (� MAILAC10RCh5 CRY ZIP <br /> G< �L I�� J � 6v� XPNONt <br /> TFNANT MALLAODRESf , �� �Vf/ / tGt-!'/V� Ci' ZJ7 <br /> CITY Ilr PHONE <br /> ARCNITFCIU vtsmN'CO MMI AUUNCSS '— CITY <br /> ,1 2v <br /> _) / lJ-��ff OL�C/ rHnNG �(7 <br /> OtHCnAL CONTnnCTOR MA0.ADDR' f I /�— CITY 7 C JtJ' <br /> ZIP PHONE <br /> /T STATIC IylCCH3C g <br /> HFCHANNAI COHTMCTOR MALL ALD11Ef3 CITY <br /> =Ip PHONIC STATE LICCI6FC <br /> PLUMSINO CONTRACTOR MAILADOn ESS CITY ZIP <br /> rNDNE SIAI[LICCIRFI <br /> CI ASS(w WOnK <br /> Il(NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> / p CONTACT PERSON O 1,1101 N0. <br /> CONTRACT rHOF WOnK NVU �t:%t,l . C�C) �Q/%/LAI <br /> OC3CRIOF WORKRK ANTISDuenOO <br /> !ITA C IAN(K FII LF1 <br /> 1,H ruscD use a1,D�llnn Nn �r I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAMU TO EE TRUE AND CORRECT.ALL <br /> LEGAL .cmruuNnr PnOPFRNIF OWNBELUW On ATT CH COPIEIR PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ` <br /> LnT OLOCK OF <- /,� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ••• NOT. THE GRANTING OF A PERMIT DOES NOT PRESUTAE TO GIVE <br /> [ AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> U/� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH 1HE STATE <br /> CONTRACTORS LAW 16.27 RCW AND 286.200 WAC. / <br /> C4iNAl=G.z- t�. <br /> r75'It T "y1 v / ?�) tl OIIYYIAu/e31K.IusfNO. �•• � •-- <br /> PLUMBING 1 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) J / I IVC-�AMNDLG UNITS-H,P. <br /> BATHTUB LT FORCED AIR SYSTEMS-B.T.U. M E.A. _ <br /> LAVATORY(WASH BASIN UNIT HEATERS-B•T.U. M _ <br /> SHOWER / I _ CLOTHES DRYERS '- <br /> KITCHEN SINK S DISP _ ) VENTILATION FAN i <br /> _ DISHWASHER RANGE HOOD - - �— <br /> LAUNDRYTRAY I -• - <br /> �_ WATER HEATER - <br /> CLOTHES WASHER - I WOOD STOVE ' <br /> _ URINAL _ _ METAL FIREPLAe E d CHIMNEY --�— <br /> DRINKING FOUNTAIN <br /> FLOOR --i FIREPLACc_INSERT <br /> DRAIN _ I _ -"'"'-- <br /> BACKFLOWPREVENTERS I HEAT PUMPGASPIPING <br /> ROOF DRAINS-RAINLEADERS_ <br /> ' �- / 'T— <br /> SINK(SERVICE—BAR,ETC.) I EXHAUST FAN i <br /> _. <br /> SUBTOTAL S <br /> PERMIT E PERMIT S -J <br /> TOTAL FEE $ ' TOTAL FEE E <br /> FOR OFFICE USE OILY: <br /> •TM?•IT St-TRACK nCAR SGIRACR_ A O; SIOC GGIOAf.K MANCH CKHIIMBSRI [[ <br /> 2450 Lf J! 9� RFCFIrT NO. <br /> VACANT SITE <br /> LOT AHtA _ FEES VAl UATION FEE <br /> JSk LyUE'� J BUILDING _ ( , <br /> IN 011r1CCO-NTi. must AI I CWA/ll Tyr[ crAcIT I PLCU+Ncr NII gPN11lMG VIII S ' <br /> PLUMBING AQ 5: <br /> Q1 Or DI NO.MFTORI S OASFM M – —L <br /> IAF.CIIANICAL ' <br /> SCUPANCYL AD rIRCFPAN'.,IREOD HEK:IITl1NITT1� ADDITIONAI.PLAN CIICCK �U 1 <br /> Nq No — A <br /> tA3ON rOn SPAINKI IRS -0pR6111L{R /,j// /0 <br /> l <br /> STATE BUILDING SURCHARGE / I <br /> :TAKE BY rLANf APPRjVFIIBY CITY OF EVEBETT <br /> LOCAL SALES runup wonKs _ <br /> TAX CODE IS 3105 TOTAL X231 JO <br />