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AF�PLICATIQ'1 FOR CONSTROJCT"-"�1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATiNG SYSTEM: J GAS J ELECTRIC .J ! <br />BUILDING DEPARrMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL 1�pLUMBING SIGN <br />OK11[R IdAIL/,0[1NE55 LIiY Z�P PIIONE <br />C,1�✓ro�. U,f d. .7oS-c..� R�•-�,,:,,Z (�e�.�l�G,�c Sc._N�c Sb'i 77 S'�v - c�S-�i <br />iL'1ANi MARAD�RESS —� �iiV ZIP PMONE <br />\RC�niECTORDf.51GNER M4ILADDRE55 CIiV ZiP PHONF <br />G/ENEFAL <br />/i . �. . <br />Alpi� pD�RE55 <br />MAII.,'1�DRESS <br />PiUM81NGCONiRAGTOR MARqDDRESS <br />,t�•n�c, .:.r C.n4..�� <br />CONiNACT PRiCE OF WOFN <br />DESGFI�JE WORR /N� SOUnRE FWTACE INVOLVED <br />PROPOSF� OSE OF BWlOING <br />LEGn� �ESCRiPTiON OF PROPE <br />lOT BLOGK <br />PAqCEI TR%IU NURIBEN <br />GONSiPUCTION IOAN IENDER. <br />NO. <br />1 <br />CITv 21P 7 <br />� iNT E�7k� fa�.z �5- - <br />CITV zIP <br />CONiACi PERSON AND PHONE NO <br />PNONE STATEIILENSE� <br />�:ySrr ,4c.J'E�fci94or�' <br />PNONE STATELICENSE• <br />PHONE STAiELICENSE� <br />— i HEREBV CERTIFY THAT I!1AVE READ ANO EXAMINED THIS <br />A''PLICATION AND KNOW THF SAME TO BE TRUE AND CORRECT. ALL <br />��o'� P�70VISIONS OF LAWS AND ORDINANCES GOV�RNING THIS TYPE OF <br />ISMOWNOEIOWORATTACHTWOLOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oF NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE <br />AUTHOFITV TO VIOLATE OR CANCEL THE PROVISIONS OF AfdY <br />OTHEP, SlATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BY TH[ <br />OWNEF OF THIS PROPERTV TO PERFORM THF. WORK FOq WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTOFiS lAW 18.27 RCW AND 296200 WAC. <br />7ESS,'�EIE�MONENUMBER <br />�� L/c>-S� <br />sGvetunc ouE <br />�/,il ....._._.. — <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHGWER <br />KITCHEN SINK 8 DISP <br />DISH WASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRIYKING FOUNTAIN <br />FLOOR DAAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—PAINLEAC <br />FOR OFFICE USE ONLY: <br />FRONiSETBACR REAP 5ETBACK <br />iYYF Of LOqSi <br />S12E OF BL�G <br />occuvnNc�iono <br />REASON <br />INiArcE �V <br />OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />A�'C—NHNDLG UNITS—H.P. ' <br />FORCED AIR SYSTEMS—B.LU. M E.A. � <br />� UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILAI'ION FAN <br />RANGEHOOD <br />� WATER HEATER � <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />f SI�E SEIBALK <br />lOT AR6� <br />NO OF STOR:ES <br />FIFE SPRINKLERS REO'D <br />rine n�an�a neoo <br />Plr1NS APFqOVE� BY <br />onrE <br />METAL FIREPLACE �WOOD BURNING) � <br />FIREPLACE INSERT <br />HEAT PUMP ' <br />GAS PIPING � <br />'iacn��r si*e FEES <br />. YES : � NO BUIL0ING <br />acw.�.n �,00�owi�u•,cur,�is — <br />c>cv= PLUMBING -- <br />BnSEM[Ni MECHANICAL <br />� _ YES .--� NO — <br />HE!aHT uMrtnnCv ADDITIONAI PLAN CHECN <br />OTNEF <br />STATE BUILOING SURCHARGE <br />CIiY OF EVERETT PUBLIC WOfiKS <br />LOCALSALES - <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL 5 <br />PERMIT 5 <br />TOTAL FEF 5 <br />FEE � RECEIPTNO <br />