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APPLICATIMI FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> --- - � <br /> f HEATING SYSTEM: J GAS ELECTRIC J ____ ___ ____._. � <br /> BUILDING DEPARTMENT ` � '-- - <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> P P MML/DDRESS Crtv :i� ���ONC <br /> ��i�/ �!'I c� �'�/.' s r�����71_" 9� ��=5� -- <br /> ur�nrut Mni�nocnEss u�� ��r rr�orve <br /> �83o C q d� /��l -- <br /> nnantEcronnesicHen �nniinooaess r.irv nr w�oN[ <br /> �G NCRAICONiRACfOq 1dAil�f]DRF.55 CIiY 2iP PHONE STRTEUCENSE/ <br /> �/%1 /�Jc.4�,"�%c.P�—�A�hc <br /> M1IECH�NIUICONfP.RC101i MAILRD RE55 CRV IIP P110NE STAlEIICENSEt <br /> PllllUpiNGCONTRRCTO� MMIADDHE55 pTV I�P PNONE 51qiELICENiEI <br /> fONIR�C(PPICE Of WORN <br /> D[SCR19!WCRN 11ND SOl14RE fOOTAGE INVOlVEO CGNTRLT PFRSON�ND PHONE ND <br /> � �-�v� �.e�..x�-- _ --- <br /> I HEREBV CEATIFY THAT I HAVE READ AND E%AMINED THIS <br /> ` yROPO5EDU5E OF pUIIDING APPLICATION AND KNOW iHE SAME TO BE TRUE AND COFRECT ALL <br /> X C�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGQ�ESCRiPiIONOf PRO^EN7Yi5NOWNpELOW ORAtTRL 1 c riesi WORK WILL BE COMPLETED WITH WHE7HER SPECIFIED HEREIN OR <br /> \� NOT. THE GRANTINCa OF A PERMIT DOES NOT PRESUME TG G�VE <br /> �C ior � e�ocK — ov � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS CF AN� <br /> — �—�, ,�� .��_�T�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � "'�`" PERFOR�IANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> ��aceL TAX I D NUAIo�P/� D� '�I^�, CONTFACTORS LAW 1B.27 RCW AND 296.200 WAC <br /> y UW W <br /> CONSTRUCt10NLOANLENOEN ADORESS.TEIEPHONENUMBER — ` <br /> _ �� /�?eQ.�a�,� 3-3/- 9� <br /> PROJECT ADORES "ON "" °��� <br /> .� 32 � � ,��,,,ss,��,��, ,., - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLI 7NIT5—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B,T.U. M E.A. <br /> LAVATORY�WASH BASIN) � UNIT HEA7ER5—B.T.U. M <br /> � SHOWEii CLOTHESDRYERS _ <br /> i(ITCHEN SINK 8 DISP VENTILATION FAN _ <br /> OISHWASHER RANGE HOOD <br /> L4UNDFV TRAY ' WATER HEATER _ <br /> CLOTHES WASHER WOOD STOVE <br /> i URINAL ' METAL FIREPLACE(WOOD BURNING) <br />� DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br />� BACKFLOW PFEVENTERS GAS PIPING � <br />' ROOF DRAINS—FAINLEADERS E%HAUST FAN �� <br />� SINK�SERVICE—BAR.ETC.) � � <br /> � <br /> SUBTOTAL $ SUBTOTAL E /7 <br /> I PEHMIT S PERMIT 5 <br />' TOTAL FEE $ TOTAL FEE S --.-� <br /> FOR OFFICE USE ONLY: <br />' FROMSFTB�CN �EpA5F.T0ACN SIDES[t�C �l4NC��f NNUMIl[R fCE flFCflp plp,/(� <br /> �lJ� �c7 � 7� � / � �,!/ "• 1• "� , '_ /`�7QQ <br /> usezoNe ioT�nrn VRCANTSii[ FEES VALUATION FEE <br /> .VES NO pUILDING ` �� <br /> _�-z- _ �o ,. . ,��.,,,, �.. .�,� --- - - --- �,� �- - <br /> L — ) <br /> iviy G!LOfl51 NO �SiORiES �� <br />� �� ( W""3 � PWMBING ���_ <br /> �L <br />' 1S5�4p�pp t fiRESP(IINnIER5RE0�� BRSfMFNI / MECHANICAL �D� <br /> sr `' YES ✓NO <br /> i �'y Sf R ry� ADDITIONALPLANCHECK <br /> OCCUPPNCYl9R0 FIREFURMREOD NFIC��111MIl�ilO�y - <br /> i � �f¢ / ) <br /> A O L�O__ OTHER / i <br /> II RE�SON <br /> STA1E BUILDING SUFiC11ARGE � �„f U <br /> inreee o� ����+s nneN veo ov CITY OF EVERETT PUBLIC WORNS ;�U IG� <br />� �J LOCAL SRLES <br /> nnrr � TAX COUE IS 3105 rorn� � � — <br />