Laserfiche WebLink
- - - - _ ... . �T ��.�"' <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT^ <br /> ., : <br /> BUILDIN(3 DEPARTMENT . ' HEATING SYSTEM: AS O ELECTRIC O <br /> 259-8810 ' � <br /> ❑ DEMOLlT10N O COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING O SIGN <br /> �'��aC� E,�� a .� p C`4 o r� ��r�j o��C�csr� �ioLe� �Q 7 e )�-.'7 x 2(��_ 59.�08'`,� <br /> ieYwr . �oa�a pm z�r �noN[ <br /> A�Ci�C�O110E�qNER. WLAOOIIfH CiTY Z�P PIqNE • <br /> 1{..�� <br /> OEMML�Oq1TMCT011 MAlAD011EH CITY Z�� ►1101N tT/1TEN0[N�E/ <br /> 1 � <br /> WLIDOI�EN CITY i1P ►NOHf �7�T�1 <br /> '�.��J�.� �1/O �1��� I � (�� ����.,-�4�'�01 ,�. 9•�3�.► �I 1�1+�J. <br /> ►j{IINq 1011 WlADD�EN CITV 21P � PMpIE ST�tEIICEN9E/ IO31ZZ <br /> CONIMt.T AIICf p WOIY� <br /> �� <br /> DE �OIMIR f00T�0E NVOWED GONTACi PERiON N7D INONE N0. <br /> � . <br /> ` � <br /> — ' i HEREBV CERTIFY THAT I MAVE READ AND E%AMINED THIS <br /> rNxoe[Du�[or AppUCATION AND KNO'N THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND OR�INANCES GOVERNING THIS TYPE OF <br /> uoKoe�clarnoeqmaenn�s��orm��owon�rr�cnmoca�¢si WORK WILL BE COMPLETED WITH WHETHER SPECIFIED MEHEIN OR <br /> NOT. THE �RANTINO OF A PERMIT DOES NOT PiiESUME TO 61VE <br /> �oT Moa a► AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> C� -� � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WMICH <br /> APPLICATION IS MAOE AND I COMPLY WITN TME 8TATE <br /> ►�T(��•o•�� CONTRA TOR� 1B.27RCWAND2�8.YOOWAC. <br /> oorw�nucfah wiw uMoe�,�oo�u�r�un�oN[�n <br /> � � y <br /> �aecr�oo�sw � , � °", <br /> + 1.���11iM1MfiSIK,fMf Np <br /> PLUMOINO MECMANICAI <br /> N0. � TYPE OF FIXTURE OH ITEM fEE N0. 7VPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—AiHNDLG UNiTS—H.P. � <br /> BATHTUB ' FORCED AIF SYSTEMS—B.T.U. . M E.A. ' <br /> UVATORV WASN BASIN UN�T HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRVERS ' <br /> KITCHEN SINN 8 DISP VENTIlATION FAN ' <br /> �ISNWASHER FANGE HOOD � <br /> LAUNDRYTRAY WATER HEATER ' <br /> CLOTMES WASHER � WOOD STOVE � <br /> URINAL ' METAI FIREPIACE(WOOD BURNING) ' <br /> DRINKIN(i FOUNTAIN � F�REPLACE INSERT � <br /> F100R DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DHAINS—RAINLEADERS EXHAUST FAN � <br /> $INK SERVICE—BAR,ETC.) � <br /> � <br /> � � <br /> i � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S� SUB TOTAL S ' <br /> PERMIT f PERMIT S � <br /> TOTALFEE S ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> PIpNT�[ir161( qEAp6ETMC1( SIOESET6�CK PI�NCNEGKNUM9ER FEE RECEIiTNO, <br /> �� ICTME� v�c�tlite FEES VALUATION FEE <br /> ^ YES ..7 NO BUILDiNG � � <br /> M[pWql. NO,WGTOIIIEi Otcu�wcr roaorrt�uxcuvnt i <br /> a�'� PLUMBING i <br /> 8130rR00. flRE6PRRN4ERSRFRD e:SEMENT MECHANICAI � � <br /> ❑ YES ❑ NO � <br /> OCCUMi11CYL011D Fh1ENARMNE09 MEqMIMIT�TqN ADDITION�LPIANCHECK � i <br /> OTMER • � <br /> �A� STATE BVILOING SURCMAFGE ' �, i <br /> MTN(E�Y MN4A►PROVEOBY �( CITY OF EVERETT PUBL�C WORKS � <br /> I LOCAL SALES , <br /> o„TE TAX CODE IS 3105 To*�� ; <br />