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APPLICATIC"7 FOR CONSTRUCT"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT r HEATING SYSTEM: ❑GAS ;]ELECTRIC l�.U ug <br /> 259-8810 <br /> I 1 DEMOLITION COMBINATION bC BUILDING f 7 MECHANICAL I 'PLUMBING SIGN <br /> OWNER MAIL�DDNESS CITV 21P PHONE <br /> �I,,,-.,,.,,�Ft Il��i.w� 7vd7 P�,,«� Lk. ��RJ� y�ae3 3f3-ka�i <br /> TEN� T AUIL�DpRE55 CITY 21P PHONE <br /> S" MC S r' �I� �-� <br /> �RCMITECTOROE516NER �A��I�DDRE55 CITY 11P VHONE <br /> c��-� .� asti - s��s� <br /> fENEH�LCONTR�CTOR MML�D�RE55 CITV IIP PHONE ST�TELICENSEI <br /> �.rirstrl �'on+�• lSRO.� d3`� 5(� tiF' ,�c�k+„isti Ci�a�iG j3�/-77�3 �LA25EC � )O1 DH • <br /> MECN�NIC�L CONiH�LTOR MMl�U�RESS CITV 21P PNONE STATE LICENSE I <br /> PWMOINGCONTR�GTOR � M�II�DORE55 CITY 21P PNONE St�TELICEN5E1 <br /> cl«�,��,��; �IJm6��c�7a� si °'n ( - t�- ��g�-�Avv c��nRP � o�sky <br /> CeNTR�Gt PRICE Of WORH <br /> i� Sa 7. °" <br /> D SGR19E WOR N�Shc E FOOT E INV�VED W CONT�CT PERSOh�NO PNONE 1.0 1�� �f S'L�'1 33��- 7 7 33 <br /> id J r nQ1 t t ( .�C✓ — <br /> � <br /> �{pl,.� LIY � n_�y.�t,.��f_Q ' i HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSE�USEOFBUIlDINO �i„� (y FT (e� < c�^. �.I��e - APPLICATION AND KHOW THE SAME i0 BE TRUE AND CORRECT.ALL <br /> I ma¢ L7+x(lo...�.� I1Ut�4� �1� a PROVISIONS OF LAWS hND ORDINANCES GOVERNING THIS TYPE OF <br /> LEO�LOESCRIPTIONOFPROPFRtt�SNON?lBEIOWOR�TT�CNTWocdv�esi WORK WILL BE COMPLEIF.D WITH WHETHER SPEGFIEC HEREIN Oti <br /> NOT. iHE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> �or� e�ocK oF — AUTHORITV TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> C_� OI- F-�e't'I� �"'� p� A�c��'�'�s ��I� � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> q p o� o -�o r � I OWNER OF THIS �AOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV W'ITH THE STA?E <br /> P�RCft T�%10 NUMAfR CONTlIACTORE LAW 1B�7 fiCW ANO 79G.200 WAC. <br /> - O� �- �1 —O O Co . <br /> CONSTRUGTqNIO�NLENDEH.ADDHE55.TELEPNONE NUMBER � / n �� <br /> C .1 .1'. 1 ` ^ �7 S Y �ir1�i �c-� 7 � <br /> PROJECT ADDRE83 "s�aN.�unc o.�c <br /> � ��� �{�� f.ilvflV5Mf55l�LfN5FN0 <br /> PLUMBINO MECHANICAL <br /> NO. 1YPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. � . <br /> BATHTUB ; FORCED AIR SVSTEMS—B,T.0 M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRVERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAV ' WATER HEATER <br /> CLOTHES WASHEH � WOOD STOVE <br /> UFiINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIR[PLACE INSFRT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTEHS GAS PIPING � <br /> ROOF DHAINS—RAINLEADERS � E%HAUST FAN � _ <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> SUB TUTAL S SUB TOTAL S <br /> PERMIT S FERMIt S <br /> TOTALFEE S TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN PE�RSELB�CK SIOESETB�CN PUNCNECMNUAIBER FEE RECEIPTNO <br /> USEZONE LOT�RE� VAC�NTSITE FEES VALUATION /FEE <br /> :�l YES ❑ NO Bui�DiNG /J� ' <br /> TVVF Of GONSI NO OF STORIES aroru¢r Mo a ow[iu�urus <br /> �"�''v pLUMBING i <br /> SIZEOFBLDG FIRESPRINNLENSREOD B�SEAIENT MECHANICAL � <br /> '�' VES ;-� NO � <br /> OCCVP�NCYIOAD FIRE�URMREOD NEIGMTLIMIT�iION ADOITIONALPUNfHECN <br /> O1HER ' <br /> RE�SON -- __._—_ _ <br /> S7ATE BUILDING SURCHARQE � � <br /> iNTRNE Av Pl�NS�PPROVEO BY CITY OF EVERETT PUBLIC WORNS i <br /> LOCAL SALES —'—'— <br /> o.re TAX COOE IS 3105 TOTAL � � <br />