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APPLICATIO.4 FOR CONSTRUCTi, JN PERMIT Lrverett _ <br /> rmEY/i�F//A <br /> Tr,BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> everettHEATING SYSTEM: y GAS Ll ELECTRIC J <br /> BUILDING DEPARTMENT —_ <br /> 259.8810 <br /> DEMOLITION COMBINATION xBUILDING AECHANICAL kPLUMBING SIGN <br /> Ro OWNER p Dpncss f.ITY ZIP <br /> 5 1 (4,n �g ��fheuux� vu 98oIz 1 8(-98 �� <br /> TENANT MAIL ADDRESS CITY ZIP PHONE <br /> _ V�nnP <br /> A._' /ATECTORM^NER Ak AC9 CITY 21P PRDNE <br /> go <br /> GENERILLCONTRACTOR MAILAODRESS CITY ZIP PHONE -sisLICENSE <br /> SMP LIS Duoo/� 1 nycity D PHONE LCENSEN <br /> �� C�s/Jscz / ZIoP�►� <br /> A y H MECMANICAI CONTRACTOR M ADDRESS/,LSI DISI no p2D /OOI ���,Jq.-.J /SI Z HEI 3�"\ <br /> CC-�v MJQ l7n-�a.11 <br /> ,9 F'3[/J PIUMBINO CONTIIACIOR MA ADDRESS CITU IIP PHONE LICENSE/ <br /> y �1cE,r;-S�unD �u/m8/aX� aCk�� R4noLc) �ibretf.� 7�/3 9s 7 Puyb75Lq)0'Z <br /> tvL,� OF WORK <br /> 5 <br /> O Jl NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> 0 H 0 �/JfALv /� CONTACT PERSON AND PHONES NO <br /> NH C.RACTPWCE l NN <br /> H t <br /> DESCRIBE WORN AND&.CARE Fa6TAGE INVOLVED <br /> q 8 -88 <br /> O H FROT'OSEO USE OF BURDING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> GHD nPROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> F,I LEGALDESCRIPTK 01`PROPERTY(SHOWNBELOWOR ATTACNFOURCOPIFSI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> q y RI LOT SLOCK GP NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> r H H AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> t7 EA H ! �6Fr17Gn� 'Ti=K2A�E Di OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> O --. PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> c� G En j -- OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> 'qG tT1 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br /> 3 0 rA -- <br /> ln� - (olst PL s£ , X ,s , Tn enc 0/9000 <br /> PgWFCT ADDnFs9 �-541- <br /> APPLICANISCIT SUSNESS LICENSE NO AND BUSNESS NAME <br /> -� PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) A,C—NHNDLG UNITS—H,P. <br /> BA <br /> 0— / _ J FORCED AIR SYSTEMS—B.T.U_ M E.A, <br /> THTUB <br /> LAVATORY(WASH BASIN) _ UNIT HEATERS—B.T.U. M <br /> / SHOWER CLOTHES DRYERS <br /> _ KITCHEN SINK 6 DISP VENTILATION FAN <br /> DISHWASHER RANEE HOOD <br /> LAUNDRY TR/.V <br /> WATER HEATER <br /> CLOTHES WI WOOD STOVE �v!-�_ <br /> URINAL __j_ METAL FIREPLACE&CHIMNEY x <br /> �► DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> U I ROOF DRAINS—RAINLEADERS _ EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.( _ <br /> - � 1 <br /> SUB TOTAL E SUB TOTAL S ' <br /> ��IPERMIT $ —I— PERMIT E y' <br /> TOTALFEE E TOTAL FEE E <br /> FOR OFFICE USE ONLY: _ oa <br /> 91Af',K REARSETBACK SIDE BE TBACX PIANCHF.KNUMBFR FEE ��^ RECEIPT NO <br /> 2vF 7uL S ' 6� ' � `'lCo7 <br /> I:ZDN LOT AREA vADANT NRE FEES VALUATION FEE <br /> NZ 36 e9 �� ;fyfg;00. <br /> BUILDING <br /> TTPE IX C01IT6 ALLOWA6lE 11P1 Of COAST ACTUAL Ila~00 <br /> Ad mGx(IIRI.uYili <br /> _Al 'V -Al <br /> A/ _ / PLUMBING i <br /> i;E tX pl OF 610RIE5 nASEMENT ZTT i n A <br /> MECHANICAL <br /> •r Uri uroYP ��IT�� FIRE 6P,RFNK/LERS RE00 HE K)NT UM TATKNI ADDITIONAL PLAN CHECK <br /> OTHER f <br /> :I A6011FOR sPRNMIEns — Y <br /> STATE BUILDING SURCHARGE <br /> JAKE BY TNANs srPRovep R�- CITY OF EVERETT PUBLIC WORKS I <br /> n� LOCAL SALES <br /> las TAX CODE IS 3105 TOTAL <br />