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APPLICATIO.N FOR CONSTRUCTION PERMIT � <br /> TO 8E COMPLETED IN BLACK INK—PLEASE PRINT <br /> � HEATING SYSTEM: U GAS I,]ELECTRIC U.,�_ I <br /> BUILDING DEPARTMENT � <br /> 259-8810 <br /> CI DEMOUTION ! i COMBINATION i BUILDING � 1 MECHANICAL PLUMBING J N <br /> OWNER MAILAOJRE55 CRV ZiP PHONE <br /> r:?�e,l� . ��G; >` �,/`j( �,/,;�f ' ue, 3.5 �'— 63 <br /> � r� 1 MRILURDORESS ��� � CIYY � ZIP pHONE <br /> ���j��,�E�6 / 1 C i`� �U'/"fD�,�' f r v � �o Q�a-r Z '�a .. <br /> (�RGM�ITEFTOPDESIGNER MAI�RODRESS CITY ZIP PHONE <br /> ��`_/ C/� �l'IQ^�o � 1��-1 C-�o �t f �� ��i `'G � f k l�tn ( ,,y C/`�J�I i � S 7 ' �? /c <br /> GENcqpl CONTqACTOR MAIL AOORES CITV ZIP PHONE LICEN6E Y <br /> �'� �-�-� <br /> MECNMlICA:CONTRACTOR MAILhDDRE55 CITV ZIP PHONE STATELICENSEr <br /> PLUMBING CONTRACTOR MAIL ADOQESS CITY 2iv PHONE STAtE UCENSE k <br /> TRACT PPICE OF WORK <br /> �� <br /> DE RIBE WORK AND SpUqRE POOLIGE INVOY.VED �ONTqCT PEFSON FND PHONE NO. <br /> � � � <br /> S f�SS U i HEREBV CER Y THAT I HAVE READ AND EXAMINED THIS <br /> PROPQSEO U E OF BUILDMG APPLICATION . KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> . PROVISIONS LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPqOPERTY�SHOWNBELOWORAiTAGHTWOCOPIES) � WORK WILL COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE ANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF qUTHO TO VIOLATF OR CANCFL THE PROVISIONS OF ANV <br /> _ OTHER ATE nR LOCAL LAW REGUTATING CONSTFUCTION OR THE <br /> - � ERF ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> - OF THIS PROPERTY TO PERFORM THE WORK FOA WHICN <br /> PAqCEITA%I.D:NUMBEfl CATION IS MADE AND I COMPLV WITH THE STATE <br /> RACTORS LAW 18J27p(L'W AN `296.200 WAC. <br /> CONST9UCTIONLOANLENDER,ADORESS,TEIEPHOMENUMBER / � <br /> �7 z°t '� � - � <br /> PROJECT ADDRESS �� s� E o,,� <br /> � � Q` CITYBUSME%LILENSENO. <br /> PLUMBI MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM �-EE NO. TYPE 8F EQUIPM€NT �EE <br /> WATER CIOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. ^ <br /> . LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYER,�'i <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> � � DISHWASHER RANGE HOOD <br /> AUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) —� <br /> DRINKING FOUNTAIN FIREPLACE INSCAT <br /> FLOOR DRAIN HEAT PUMP <br /> .BACKFLOW PREVEN S GAS PIPINC <br /> ROOF DRAINS—RAINLE EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> i <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> � TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE lY: <br /> FRONTSETBr1CN FEARSEiBnCK SI�ESEtBACK PLqNCHEC NUMBER FEE � RECEIP NO. <br /> ,�ja 35.75 i(,a <br /> USEZONE LOtRPEA � VRCANTSITE FEE$ VALUATION �E <br /> � — y'y � vEs n No eu��o�Nc <br /> ttPEOiCONSi. NO.oFS1oRIE5 occucaxcv xa.ovow[wxcuxirs � <br /> cnauv pLUMBING <br /> SREOFBL FIRESPRINKLERSREO'D BASEMENT MECHANICAL <br /> n vEs r No — <br /> OCCUPRNCV lOr1C FIRE ALAflM REQ'D HEIGHi LIMITATION ADDITIONAL°LAN CHECK <br /> OTHER <br /> REASON —�-- <br /> STATE BUILDING SURCHARGE <br /> �` — <br /> iNTANE�B`/ ^� PLpNSA�PROVED9V CITY OF EVERETT PUBLIC WORKS <br /> IOCAI 5ALES �4 <br /> k.�:� ,a1E TpX COOE IS 3105 TOT�L <br /> ' — �— <br /> ` — r <br />