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APPLICATION FOR CONSTRUCTION PERMIT <br /> �^e E�ro�«a� everett <br /> ��T�oF , e <br /> everett <br /> BUILDING DEPARTMENT /� 4 _, ,,., ' <br /> 259-8810 TO BE COMPLETED IN INK—PLEASE FRINT - - <br /> DEMOLITION COMBINATION k UUILDING MECHANICAL SIGN <br /> OWNER M�RAODRESS �IiY ziP PNONE <br /> i✓ � .V /OJ� /1� l> r�-1 � _�*t. �r r � . <br /> TEN�Nt MML�ODRE55 'CrtY ZIP PHONE .�/�, �]�� <br /> ��+�1!�l�,�5 /�l:'.Z�(� �%l7 /!':'�:6� -' ��1a� `1�-�:'� —�.. �r i��F'—�� IcJ( J <br /> �RCNREG70NDESIGNEN MML�ODRE55 CItY ZIP PNONE <br /> �`{�'13�0. �"��Ql1 U_�IC� <br /> 3ENERQGONTPACTOR M�IL M)DRESS C�TY 21P PHONE �I[ENSE/ <br /> i..4t G�� .Z3��lI✓� N� 3. /�1.1t�'tvvG k���'�7� GS�/9y>O Tn.rt Gi Pi"iv <br /> MECH�NICALCOHTR�C�OR M�iUDOHE55 CiTV� � zIP PHONE �I�ENSE/ ��Kl <br /> PWMBINGCON�R�CTOR MFIL�DORE55 CITY IIP PNONE tICENSE• <br /> C1A55 OF YIORN <br /> i\ NEW X ADDITION � ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSEqT � '� BUILDIN6 RELOCATION <br /> 1ENANT IMPROVEYENT OA INTERIOR PEMODEL p:LY `'� CONT�C(PEFSON�NO PNONE NO <br /> CONTRACT PRICE OF WpRN: <br /> �ESC�RIBE W�)ORN�N�D SOU�NE POOU6E INVOLVED <br /> / " J��/ - �c " ��1-.-ti' "• <br /> PROPOSED USE aF BUtu:NIG <br /> I HEREBV CERTIFV ?HAT I HAVE READ AND E%AMINED THIS <br /> 7 J'J}i�9� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> IEO�L0E5CRIPTqNOFPq(WERTIISHpWNBEIOWORATiACNFWRCOPlE91 PROVISIONSOFLAWSANDORDINANCESGOVERNINGIHISTVPEOF <br /> �or ���7 B�OCN oF�% WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREM OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or ANV <br /> OTHER STATE OFl LOCAL lAW RECULATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK fOR WHICH <br /> APPUCATION IS MADE AND I COMPLV WITH TH[ STATE <br /> CONiRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNALI)qE OF CONTRACTOR OR�UTHOR12E0�GENT D�TE <br /> PRQIEC7AODFE55 //__�-�E���-.�-� .� ��_ '�'!�% <br /> lf/�� ��D �/_ � �.A�tlr2�.�--tiA/. �� �PPLICAhT5C1iYBO51NE55LICEN5EN0�NO0U51NE55NAME <br /> .7 7 /.vl�f���// Y/1'Y- <br /> PIUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AiC- 4iHNDI.G UNITS—H.P. <br /> BATHTUB FORCFC 41R SVSTEMS—O.T.U. M E.A. <br /> LAVATOFV(WASH BASIN) UNIT HEATERS—B TU. M <br /> SHGWER � CLOTHES DPVERS <br /> KITCHEN SINH 6 DISP VENTILATION FAN <br /> DICHWASHER AANGE HOOD <br /> LAUNDRV TRAV � WATER HEATEF <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ; METAI FIREPLACE 8 CHIMNEV <br /> DRINHING FOUNTAIN i FIFEPLACE INSERT � <br /> FLOOiI DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAfl,ETC.) <br /> � — <br /> � <br /> � <br /> SUB TOTAL S _ 3U6 TOTAL E <br /> PERMIT a PEFlMIT S <br /> TnTAL FEE S � TOLLL FEE E <br /> FRON75ETB�CK P��^SETBl1� SIOES�T �G Qd�. PI�NC EC1cNUMB R FEE �- PECEII'740 <br /> � � �� — —� �.�ly >t �1�� < < < ;3_ � , ���7���, <br /> use F�S wi�HE� ,�,/) V�CANTSITE FEES VAIUATION FEE <br /> �I �5 rw �ES X N� BUILDING �q l�� �!r{j <br /> � \ <br /> LYPFO'CONSI�lLlW1BlF 1YPEOILONSIACfWL aRwxrr yopmv¢��xLox�u ���;�..�_ <br /> tnaw <br /> Q-A/ SI�N �. 3 � PLUMBINO <br /> SqEOF BLDO NO Of StORIES BASEMEN� <br /> (.ir S� MR��7 MECHANICHL <br /> ��Sf 2L�i..♦. VES X NO <br /> OLLIIPANCYLO�D FIAESPRNRLEASREOD HEIOHILIMIT�iION OTHER <br /> �.J VES X NO ST�TE BUILDING SURCM�ROE ( �/ -� <br /> RF�SON FpR yPRINXlERS <br /> STATEENERGV.SURCHAHGE ; <br /> �PPL�CQIq��CGBY PLANSAPPqOVEDBV G�TyO� EVERETT PUB�ICWORKS <br /> 9�f- LOCAL SALES ' <br /> TAX CODE IS 3105 Tou� � 7 ; ' j� <br />