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APPLICATION FOR <br />TO BE COMPLETED IN <br />AUILpING DEPARTMENT I "` �' ", � <br />259•8810 <br />❑ DEMOLITION U COMBINATION ;�ILDING <br />ONNEO '� I �D ESS .(.� y q <br />l..n � �_)~� . /._ " ��/�. _ �_ . /! i <br />uu� �ooness <br />MAIL ADDRESS <br />CONTP�CTOR <br />MAIL ADDRE55 <br />. ��/ ..� <br />PqICE OF <br />OESGRiBE WOflN �NO SOU�RE FOOUpE INVOLVED <br />USE OF BUIlDINO <br />IEGu. <br />LOt � �" � BIOCK <br />n � <br />IJ��« � <br />P�RCELTA%ID.NUMBER <br />PROJECTADDRESS <br />�3/ 3 <br />PLUMBINO <br />T— <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATOFY (WASH BA! <br />SHOWER <br />KITCHEN S�NK 8 DISP <br />DISHWASHER <br />LAUNDflYTRAY <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ISTRUCTION P�RMIT � <br />INK—PLEASE PRINT <br />❑ MEC-�HA-�NICAL -�l PLUMBING ❑ SIGN <br />IWCI ✓�r/J PNpE <br />����� u�.0 ��� s s3 - 3; 5�= <br />• �Il^I 21P � / GHONE <br />/1 �' CITY�'� ' 21P PNONE �3Y � 69 7 <br />�7 �O�('�'..7'LtlCs{�f � �i/y///�Avr.�.I <br />CI;V � P PN NE /,� $T�IELICENSEI <br />Hby/ S.�lvarf,� �.r�e ,�erP,�j' Cr%dl �vof �q,� � //�D7 <br />CITY , Z PM'1N� STATE LIpQNSE � <br />CITY � A ZIP PIIONE STRE LICENSE 1 <br />TWO <br />( <br />,n��9_a3ii <br />� CG•' <br />SUBTOTAL <br />PERMIT <br />FOR OFFICE USE ONLY: <br />FRON75ETB�CIs REAH'tEiB�CK <br />� � ' <br />USEZONE LOTANE� <br />Z� � <br />TYPE Of LONSI NO OP Si0R1E5 <br />/�IZ �f <br />p t Sf i <br />:,ccuruicv�oeo <br />N/A <br />FEASON <br />FIRE SPRINNlER51 <br />�E5 <br />FIRF ALARM PEO'D <br />INIANEBY I PUNSAP0�O1VED9Y <br />�, <br />S/�✓4i <br />SIDE <br />GOHTACT PERSON �ND PIIONE NO <br />/ � . n l�� <br />i HEREBY CERTIFY THAT 1 HAVE REAO AND EXAMIN[D THIS <br />APPLICATION AND riNOW 7HE SAME TO BE TRUE AND CORpECT. ALL <br />PPOVISIONS OF LA'NS AND ORDINANCES G�7VERNINO THIS TYPE OF <br />WORK WIIL BE COMPLETED WITH WHETHEF' SPECIFIED HEREIN OR <br />NOT. THE GRAN�ING OF A PERMIT DOES N��T PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TIiE 1'HOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINC� COIISTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I Ald AUTHORI2ED BV THE <br />OWNER Of THIS PfiOPEFTY TO PERFORM TViE MORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV W�TH THE STATE <br />CONTFACTORS LAW 18.27 RCVJ(.AND 296200 WAC. <br />TYPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T,U. M �70TJil �. <br />CLOTHES ORVERS <br />VENTILATION FAN <br />RANGEHOCD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREF .CE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />r �- <br />FAN <br />�ves ❑ NU ew�oiNc <br />OC[IIM4CY MOOfpWfllllpllY��b <br />��a� PLUMBINO <br />BeSEMErv7 � MECHANICAL <br />�� YES L�( NO -- <br />MEIONQT IIMIUTION AD�ITIONAL PLAN CHECK <br />2 �/ • OTHER <br />STATE BUILDINO SURCHARGE <br />ClTY OF EVERETT vuoucwonKs <br />LOCAL SALES <br />rev r nF ic atnc *�.e� <br />SUB TOTAL S <br />PERMIT E <br />TOTAL F'cE $ <br />j O, i*� <br />E � RE <br />F�3E <br />_ �_ <br />�� <br />��' .l) �'��1 <br />i <br />(�� �O> <br />—r— <br />i <br />M; , � ,l. <br />