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APPLICATIO'� FOR C�NSTRUCT►'�N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT �1(: i : ; �/+� <br /> � i r -�r- �� � - <br /> HEATIN:i SVSTEM: ,�GAS J ELECTRIC J L��tTT <br /> BUILDING DEPARTMEIJT L_— _— —__ , _ ___I <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL CIPLUMBING SIGN <br /> ONhiH M�RADD�ESS Litv ZiF PNONE � <br /> ��.� N��b aa�A�- � �$a�-� _ 3�� - �a3 i __ <br /> iEN�NT MAIL R��RE55 CItY 21P PHONE <br /> �qLHITELTOPDE5IGN[R M�ILAOp�iE55 CiTV I.iP PNONE <br /> GENER�I LONiR�CiOR M�IL ADDRE55 C17V ZIP PHONE STAiE LICENSE• <br /> MECNANIC�I CONTR�CTOR M�IL R��FE55 CITV ZIP o1qNE STAtE LICENSE• <br /> �<o �3�3� nJ� ta�►�r K,rKk�D w� 8a�- 3333 �roR�� �r�5i�l� <br /> PWM9INGGONfR�CiOR M�R�D�RESS UiV ZIP PIqNE STr1iELICENSE� <br /> CONTR�CjP�li1�SJ N <br /> af <br /> DESCRIBE IYORN�ND SOWPE FOO1�uE INVOIVED LONT�GT PERSON AND PNONE NO <br /> �r�,�t,ua.� �►.Q� ,�u j o;P� --- <br /> "v�� • `v� ' . I HEREBV CERTIFV THAT I HAVE READ AND EXAMII�ED THIS <br /> PROPOSf.DUiEOFBUILUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCE�GOVERNING THIS TYPE OF <br /> IEGALDESCRFTqNO'PROPERTVISHOWNBEIOWORRTACHiWOCOPiE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT — eiocK oF — — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION. THAT I AM AUTriORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I �OMPI_Y WITH THE STATE <br /> PARLfL TAM I D NUMBER CONTqACTORS L!W 18.27 qC W AND 296.200 WAC. <br /> GONSTRUCTIONiOANLENDER.�DORESS.TEIEPMONENUMBER �O I <br /> ���'"° — �`��--- - <br /> PROJECT ADDRESS s�cv,�o�n o.*c <br /> n�rn.is�•irs,iinns� m� -- — <br /> PLUMEIYG MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEF <br /> WATER GLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> 6ATHTUB X fORCED AIR 5"STEMS—B.T.U. M E.A. _ <br /> LAVATORV(WASH BA51N� UNIT HEATFRS—B.T.U. M _ <br /> SHOWER CLOTHES URYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRV TRAV WATER HEAIER <br /> CLOTHES WASHER WOODSTOVE _ <br /> URINAL METAL FIFEPLACE�WOOD BURNING) <br /> DRINHING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP _ <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> AOOF DRAINS—RAINLEAOERS � EXHAUST FAN � <br /> -•-- <br /> SINK(SERVICE—BAH,ETC.) ._ <br /> SUB TOTAL E C �:i0 TGTAL S _ <br /> PERMIT $ PERMIT 5 <br /> TOTALFEE $ ` LIOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> LPONTSETBACN RERRSETBACN SIpESEiB�CK PLFNCHECMNUMPEN FEE RECEiPLNO <br /> usezorie ioreae� we�r+rsrt� FEES VALUATION FEE <br /> -. � VES NO BUILDING <br /> tYPE Oi CON51 NO OF STORIES aru>µn No a�owtu�rr,�:xn5 -- � <br /> �'""j° PIUMBING <br /> SiZE OF BlOfi FIRE SPRINNLERS REO'D BASEMENT MECHANICAL <br /> �- VES � � NO �"��� <br /> OCLUPANGVLOIIO FlFE�IIRMPEOD NEIGHTLIMITATIOf! ADDITIONALPUNCHECN <br /> OiHER <br /> RE�SON —�_ __---i-_--- <br /> StATE BUILDING SURCHARGE <br /> iNiAKE Bv Pl�NS AP��iVOVFD Pv CITY Of EVERETT PUBLIC WORNS <br /> LOCAL SALES <br /> p,,,i TAX COUE IS 3105 TOTAL <br />