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APPLICATIC I FOR CONSTRUCT" IN PERMIT <br />,* <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION --BUILDING MECHANICAL PLUMBING SIGN <br />OMI[R M"L MDR E56 LRY IP rWylC <br />�,cy/��—rTiu - � zscs ;,il <br />TENAM MAIL ADpRF66 UIT iIP rIK»,F <br />ARGNR[Ci g10E6KWER MA0.AWRE 65 GIFY IR PH E <br />OENFRAI L(INiRACTOR WL MDRE66 CRY 2N PMQ1E 6rAlE LILEM6EF <br />MEOHANGAL CPRwlm MAL ADDRESS CRY ZIP PHONE 67AM LICENSE E <br />PLIMBMDN AicT MAL AOR11ES5 ITfY lIP PN'JNE 6rA1E LILEN4E• <br />L wnnngTnV9XRPL INSERT BUILDING RELOCATION <br />CONIACT PPEE7R,9p�N AND PI�YJI/IF W <br />��'/� <br />LDNrflrcl PRlcEarACRA <br />d��K-fT��s - <br />DE6�CR79F W WF AND 6WARE POODIAOF LNV0.VED <br />U S O P'- I IJU/cd� QJ <br />1 HEREBY CERTIFY THAT I HAVE READ AND ED THIS <br />vRDPos[DLLSEaeVAoma <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANDND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHEL HER SPECIFIED HEREIN OR <br />ifiDu oEscRmiroNa PIIOPERT ISNown RELON OR ",*ACHrwRcovNsl <br />Lm BLQIR a <br />140T. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRO% ISIONS OF ANY <br />0111ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATWN IS MADE AND ! COMPLY WITH THE STATE <br />CONTR/..TORS LAW 18 27 RCW AND 206200 WAC. <br />09 ✓�caND.c�.4si .�' � <br />f4HA,ME M,L <br />vRaEcr AooRFss <br />c•. eLrs.ry <br />o-,. <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM FEE <br />NO. <br />TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />A'G-NHNDLG UNITS-H P. <br />BATHTUB <br />FORCED AIR SYSTEMS--B.T U. M EA. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B i.U. M <br />_T <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE E CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />E%HAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />SUBTOTAL E <br />SUBTOTAL E <br />_ <br />PERMIT E <br />TOTAL FEE E <br />TOTAL <br />TOTALF'£ EE <br />FOR OFFICE USE <br />FROM,Z ALY. <br />ONLY: <br />REAR 6EigACK <br />SOE 9E10ALM <br />PLAN CNFCANUM6Efl <br />39v <br />EE <br />RECEIPIM <br />NSE ZDNE —' <br />LnI AAEA <br />vAcurt urE — <br />FEES <br />VALUAnnl10N <br />FEE <br />BUILDING <br />L8 <br />YiVNM.. IR PPRUN4INn <br />rYP[d GJX16 KIAYPBIF <br />1YRa W16i. ELTW <br />PI UMBING <br />SIZE OP&00 NO.DPR'}UIE6 BASEMEN <br />ML.-,HANICAL <br />AD11TIONAL PLAN CHECK <br />ocCVPANCYIOAD nRE 6PRNaER6 RE09 KIDM LEdITATpN <br />iPRIN'IER <br />REASON FOR 6PRRW:ER6 <br />!iTAtE BU%DWL: SURCHARGE <br />WIAAE er <br />ruNSAwRDv[o ev <br />CITY OF EVERETT <br />PUBLIC WORKS <br />LOCAL SAL ES <br />TAR CODE IS 3105 <br />rorAL <br />, <br />