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� ���' ' �' APPLICATI�"''1 FOR CONSTRUCT�N P�RMIT � <br />�?� � <br />, TO BE COMPLETED IN BLACK INK—PL�dSE PRINT G I <br />� <br />BUILDING DEP.4RTMENT HEATING SYSTEf,�: �GAS ❑ ELECTRIC ❑___ _� <br />259•8810 <br />I I DEMOLITION i I COMBINATION i I BUILDING i i MECHANICAL I i pLUMBING I I SIGN <br />OWNER M�IL�ODRE55 Cliv Z�p p�pqE <br />�� �� � C��t� li�tieS �Snc Il4 �I- I��"'A�te �1 E�`�3 �c r,r [n�it��e,�\KR Q80�z <br />1EN�Nf M�R�DLNE55 C11Y zIP PIqNE <br />♦I1U111EGTO110ESIGNEII M�ILpU011Eu5 G11Y 21P P1qNE <br />��n L��'�1 C�x,p <br />GENERAI^pl ACTOR MML�ODA,E5`5 CITY 21P PHONE ST�iELIGENSE� <br />C }`'�'�Jq[ b B'j• _1�1A�1�RCNC�gBC.L. <br />MECN�HICALCd1iflAC70qC�ORE59 � CI7V TIP � I^ Pq�ryE S7�TElICEN5E1 <br />1'LUMBINOCONfR�Ci0f1 MARADDf1E55 <br />CUSSOFWORK ' <br />I_I NEW I I ADDITION I I ALTEPATION <br />CIIV <br />PNONE ST�TEtILEN5E1 <br />I I HEFAIR I I DEMOLITION I I WOODS70VE/FRPL INSERT L I BUILDING PELOCATION <br />GONT�CT PERSON �ND PNONE NO. <br />LONiR�CT PRICE OF VIORK <br />DE6CRIBE W(N1X pN0 60U�RE FOOTpOE INVOIVED <br />.I��l�c�t�C?XIC� IU55-f l� <br />PRqPOSrp USE OF BURDINO <br />LEOQ OESGIIIPTION OF POOPERTY (SIIOWN BEIOW OB �iT�CH F W q COPIES� <br />LOT_� _ E�OCN pF �p ,�� - vv <br />' �n�/ �6 <br />� <br />rrro.�cr nooness <br />� � �.32 �,�5'l��- �� S .c <br />PLUMBINO <br />NO, TYPE OF FIXTUFlE OR ITE <br />WATER CLOSET (TOILFT) <br />BATHTUB <br />� LAVATORY (WASH BP S�N) <br />S�I OWER <br />KIT EN S�NK 6 DISP <br />FLOOR DRAIN <br />�ACKFLOW PREVENTERS <br />ROOF DRAINS—RA�NLEAC <br />SINK BERVICE—BAR. ETC <br />FOIi OFFICE USE ONLY: <br />Ff10NfbE78ACN OEMSEIBACN <br />�_• . <br />� � I a3s� <br />IYI`FOfCONB.�IIOW�BLF IYVEOfCONS�ACIu�I <br />_�ao4 f 4� <br />OCCVP�NCYLO�� <br />NO OF <br />iIFE <br />� <br />FEE <br />S <br />S <br />SIDE SETB�CR <br />s� �o . <br />V�CANLSIIE <br />� HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW *HE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHE111ER SPECIFIED HEREIN OR <br />NOT. THE GAANTINO OF A PERMIT D�CS '�T PRESUME TQ GIVE <br />AUTHORITV TO VIOLATE OR CAIJGEL TMt PROVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW qEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONS�RUCtIOW. THAT I AM AUTHORIZEC BY THE <br />OWNER OF THIS AHOPEHTY ?O PL"RFORM THE WORK FOR WH�CH <br />APPLICATION IS M�DE ANpI � COMPLY WITH THE STATE <br />CONTRACTORS LAW 18R7 RCV�I�AND 29fi.200 WAC. <br />-, / <br />�AMNDLG UNITS—H.P. <br />;ED AIR SVSTEMS—B.T.U. <br />HEATERS—B.T.U. M <br />HESORYERS <br />METAL FIREPLACE`d CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />BUILDINO <br />acuwx+ raamrniiwuxiis <br />naie ( p�UMBIN� <br />BnSEUENT MFCIIANICAL <br />pEpqt�ipiT�pq AUOITIONALPLANCHECK <br />_ w 1 _ <br />oTAiE DUILDIN6 SURCHMGE <br />CITY OF EVERETT PUBLIC WORNS <br />LOCAL SALES <br />TAX COOE IS 3105 roTa� <br />' %J <br />MtF <br />SUB TOTAL S \; <br />PERMIT S —� <br />TOTALFEE S � <br />/ RE PT N0 <br />3L� ��f. '� � <br />VALUATION FEE <br />56 �-1 I ��%lD ; " <br />"""F_ <br />T <br />�' <br />— /O I <br />I � <br />1 <br />� '.� � <br />/7 /, i � <br />