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� 1 I APPLICATIQ"' FOR CONSTRUCTf"�N PERMIT � <br /> , � <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS 'J ELECTHIC J ___� <br /> BUILDING DEPARTMENT � <br /> 259 8810 <br /> DEMOLITION COMBINATION BUILDING 9CMECHANICAL ; ' PLUMBING SIGN <br /> OWNER MAIL�f10AE55 / CILV ZIV NMONE <br /> T,,,,�� � �–' DY�S' I7'i+/c .'E' Hv'E C✓C-7Pr�Tr 9�'�'O/ cJ.Sd– '7�9�5/ <br /> TtNANt MMLADDFE55 CitV 11V FMONE <br /> ARCNItECTONDESi6NFR M�R�DDFE55 ��T� z�P ��� <br /> GEN(RJ'_CONiP�CTOR MMI�DUHE55 f.irv ZIP 1'HONE SiATELN:ENSE� <br /> MECNANN;�LCONTRACTOR M�II�U�FE55 GLV Lil� 9��sJG, P�cB1E/f's/.�j�je7T�TElICENSE� <br /> T/� �,(, t/✓F/PLiV SY�lE�9 � I9/'�/ �I �TJ//�1v� ��'NNL C04 Ti1B'7qLSSQ(,�ru <br /> PWMBINGCONiP�CTOR MAII�DUAESS CrtV 2iP PHONf SiATEIICENSE� <br /> CONTF..GiPRICE Oi WOA�jp� ' <br /> I? �a 0 —� <br /> OESCFIBE WOR1t�ND SOU�AE FOOTA6E INVOLVED CON1��T PERSON�ND PNONE NO <br /> ��/' eP�/J - <br /> o� �',c O C K <br /> i NEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF Bl11LU1N0 APPLICATION AND KNOW THe SAME TO BE TRUE AND CORREC7. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING TMIS TVPE OF <br /> LEOAlDESCRIPTIONOfP�'OPERTVISHOWNBEIOWOR�TT�CHTWOGOVIES) WORK WILL BE COMPLE?ED WITH WHETHEF SPLCIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 'f0 GIVE <br /> �ot e�ocK ov -------- — q�7HORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR l HE <br /> _ PERFOFMANCE OF CONSTRUCTION. TNAT I 4M AUiHORIZED BY iHE <br /> OWNER OF THIS PROPERTV TO PERFOFM THE WORK FOR WHICH <br /> ./.awAro+� _— APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> P�RGEL TAN 1D NUAIBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> `f3 98-s YY - aJ.3 - Ua 0!� <br /> LONSTRUGTIONLO�NLENDER�DORESS.1ElEPHONENUMBEC x /) I���C—� `���–�-- <br /> — �1 A o �f <br /> PROJECT ADDRESS /� s�"`��"��� <br /> 9d�o .Q,9KC—� N✓E cmn�.�sne5suuptiir�o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUNE OR ITEM FEE N0. TVPE OF EOUiPMENT FEE <br /> WATER C�OSET�TOILET) NC—ArHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIF SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) __ UNI'HEATERS—B.T.U. M _T_ <br /> SH7WER CLO!HES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN T_ <br /> DISNWASHER HANGF HOOD _ _ <br /> LAUNDRV TRAV ; WATER HEATER _ <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE�WOOD BURNING) _ <br /> DRIMKING FOUNTAIN FIREPLACE INSEFi __r_ <br /> FLOOR DFlAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING _ <br /> ROOF DRAINS—RAINLEADEHS E%HAUST FAN <br /> SINK(SERVICE—BAR.ETC� <br /> � — ---r-- <br /> SUB TOTAL 5 SUB TOTAI S __ <br /> PERMIT 5 _ ___ PERMIT 8 � _ <br /> TOTALFEE 3 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> �ROVISETBACN FEARSE7BRCK SIDEL_TB�CN <br /> PUNGHECxNUMBEP FEE RECEIPiNp <br /> U'iF ZONE LOT�HEA <br /> V1C�NT S�TE FEES VALUATION FEE <br /> '�. VES � NO aw�oiNG ._.�___ <br /> rvoEO�GONS1 � �STORIES � acu�urt. xoamm.uMccun �-- <br /> tR0°v pWMBING ._ <br /> Si2EOFBlDO FIMESPRIN lER5PE0'0 B�SEMENT MECMANICFL �___ <br /> r�,, VES � � N� — <br /> OCCUPANLVIOAD GIFEMARMREOD NEIOMTLIMIT�TI(NI <br /> -- AODITIONAL PUN CHECK <br /> OTHFR <br /> RCA4]N <br /> STATE BUILDING SUACMARGE _ <br /> INi�VF BV RANS�VPROVE�BV CITY OF EVERETT PUBUC WOflKS <br /> LOCAL SALES <br /> o�*e <br /> TI1X CODE IS 3105 T�r�� <br />