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A�PLICATIa" ; FOR CONSTRUCT; )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />HEPTING SYSTEM: J GAS J ELECTRIC J <br />DEMOLITION COMBINATION BUILDING <br />01' lF.R I,IAILADOPE55 CI(Y <br />��Y�IN C�n)S�I�CI�Jrv l"U<.t� <br />rc�ur�r ren�iaoon�ss � rtv <br />D�2,�"� <br />. CHIIEC70RDESIGNEF I.IAILAD�FESS CitY <br />�[�Iv1 L <br />GENERALCJNTCACiOR I.IAR�D�RE55 CdY <br />1AECHANIC�LCONTPACiOR RIAILFpDiiESS CITV <br />�il PIuM�3 ti�.w •,�f� IKv;�. ��. u�r MS <br />PWA�BINGCGNTRACTOR MAILAODRESL C'iV <br />GONTR�CT PRICE OF WUqN <br />OESCR18E WORK AND SOURNE f00Tr1GE MVOW EO <br />use <br />LEGAL UE54GPTIJN ONPROPERiV ISNOWN BEIOW OR AT fnCH TWO COPIES <br />/ <br />�OT BLOLK OF <br />PAPCELTA%ID.NUMPER III ' <br />GONSlRUCTIONLOANLENDER.ADDRESS.TEIEPHONLNUM9ER <br />PR����A�DDRE�S �RI,�r L�^�C �v<.-c("f" <br />� ) �xZJ <br />PLUMBING <br />N0. TYPE OF FI%TURE OR ITEM FEE <br />LAVATORY�WASH BASINI <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DflINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENTERS <br />ROOF DRAINS—RA:4LEADERS <br />SINK ISERVICE—BAR, ETC.) , <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONi5E7BALN REARSETBACN <br />4SEIOhE IOTAREA <br />rrvE or wr+sr NO OF Si0RIE5 <br />512EOFBLDG FIRESPPiNNLERSREO'0 <br />OCCUPANCVLOAD FIREAl�R1.IRE0� <br />REASON <br />MtANEC" P�ANSAPPROVEDOY <br />DATE <br />MECHANICAL <br />GONiAGT PEFSON AND PNONE NO <br />G�pLUMBING <br />�•G'�i p <br />�„oNE <br />PN011E <br />PHONE <br />PMONE <br />� S} �`�/� <br />PHONE <br />StATE IICEHSE r <br />5i4iE IIGENSE / <br />STAt�I� N15� <br />SIGN <br />i HEREBV CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED �VITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br />AUTHORITY TO 'JIOLATE OR CANCEL TNE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSI RUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNEH OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY Wi"' THE STATE <br />CONTRACTOAS LAW ttl.27 RCW AND 296 200 WAC. <br />wrz <br />A'C—A: HNDLG UNITS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE �WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PLMP <br />GAS PIPING <br />EXHAUSTFAN <br />$IpESET�ACN PV�NCNEfNNUMBEfi FEE <br />VACANT SITE FEES <br />yes _ No ow�oiNc <br />occ:,nv.cr rvoorpwtu���cews <br />�.`�o`� PWMBING <br />easEMeNr MECHANICAL <br />. - VES � �: NO <br />NEi,n�uMrtqlloN ADUITIONALPLANCHECN <br />OTHER <br />S1ATE BWLDING SURCHAfiGE <br />CITY Of EVERETT Pl1BLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTALFEE 5 <br />RELEIPT NO <br />