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APPLICATIC'� FOR CONSTRUCT' 1N PERMIT �✓� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING�YSTEM: J GAS ELECTRIC U I <br /> BUILDING DEP.AfiTMENT <br /> 259-8810 <br /> I I DEMOLITION COMBINATION I I BUILDING f l MECHANICAL f_l PLUMBINQ SIGN <br /> ER /� � / MAII ApORF.55 CIi= / ZIP PMONE <br /> n � ( hii,yL(�.,,s,� ���1(� �Cusno t"�iie�Y 9�20'j ��.�"J�.S y .._.. <br /> TENIINT MRII��DqF55 CITY ZIP PMONE <br /> �RCNITECiOF0nE51GNER M�IL��O�R/ESS p CrIiY / ^21P / PHONE <br /> P�n; L/tSi��n 3��7 1 ()roaG�Wr.% rVP�I�"� '7�l U �l 2 5 � , g1 9 <br /> GENFR�f,ONTR�CTO M�IL�OORESS CItY IIP PMONE ST�TEUCENSE• <br /> D�.�,�er- _. <br /> MECH�NIC�L CON�R�CTOR NML�DORESS CITv IIP PNONE ST�1E IICENSE I <br /> PIUMBINGCONiP�CiOR M�IL�O�RFSS CI7Y ZIP PNONE ST,ITELICENSE/ <br /> CONTRACT PNICE OF WOAN <br /> /�,��J`J — <br /> ��OESCRIBE WORN�NO SWARE FOOT4GE INVOWEO G LT SON RND PHONF NO <br /> JJ( �,./n e� <br /> /(/`C�/F7Un //'n ,ny �!/ � / N� — —. __ <br /> n J�- <br /> yJ S� tI , i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 7HIS <br /> -�faoro ouseovrwioinc APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �!' � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING iHIS TYPE OF <br /> �lEO�LDESCRIPTqNOFPR9PERTV�SHaWNflEIOWOR�TUCNTWOCOPIES� WORK WILL HE COMPLETED WITH WHETHER SPECIFIED HEREIIJ OR <br /> �14 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> �or eiocK oF AUTHONITV TO VIOLATE OH CANCEI THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATINC CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTV Tq PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ��RCEI iR%I UMBER J a �,�� CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIONLO�NIENDER.�O�RESS.ikLEPNONE NUMBER /� /J � <br /> �ic �t�.-� ( CA(�r �� -/����_ <br /> JPROJECT ADDRESS s�c�+�T osrt ___ <br /> 7` k, � �� � Urveusmrssi¢rrs�Nn <br /> PLUMBINO MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILE7) NC—NHNDLG UNITS—H.P. __ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. __ <br /> LAVATORY�VJASH BASIN) UNIT HEATERS—B.1.U. M _ <br /> SHOWER CIOTHES DRVEHS � <br /> KITCHEN fiINK 8 DISP i VENTILATION FAN <br /> DISHWA�iHER RANGE HOOD � _ <br /> IAUNDRY THAV ; WATER HEATEa <br /> CLOTNES WASHER WOOD STOVE _ <br /> URINAL ME?AL FIREPLACE(WOOD BURNING) _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DHAIN HEAT PUMP � <br /> �- <br /> BACKFLOW PREVENTERS I GAS PIPING I <br /> ROOFDRAINS—RAWIEADEHS E%HAUSTFAN � _ <br /> SINK(SERVICE—BAR.ETC.) � <br /> — --T � <br /> i _ <br /> i <br /> 1 _. <br /> i <br /> SUBTOTAL S SUBTOTAL S i__ <br /> PERMIT $ PERMIT $ _ <br /> TOTAL FEE $ TOTAL FEE $ _ <br /> FOR OFFICE USE ONLV: a <br /> FPONT SETB�CN REM SEiB�CN SIOE SE'BACR J PUN LHF.N HUMBGR FEE , RECEIPT NO <br /> � ✓ S � Z <br /> usetorve / / IOT�NEA vnenNrsiTE FEE8 VALUATION FEE <br /> �'� � � VES . - NO BUILDING � � ��) <br /> ivPEO{CON51 NOOF6TONIE9 rmcurn�n xnrowmiw,ur��s — — — <br /> °o� ( PWMBINO _ <br /> S12EOFBLDG FIRESPPINNLENSREO'D BRSEMENT � � MECHANICAL ' <br /> �I�LS O , . YES �VNO �__.. <br /> OGGIIP�NCVlO�� FIRE�IRRMIIWU HEIGN7UMIT�iNN! AD�ITIONALPLANCHECN <br /> 7 � i <br /> N/A_ U !�� OTHER <br /> r— <br /> REASON <br /> S7ATE BUILOING SURCHAROE �!__J <br /> � <br /> INinxE PY PL�NS�P"RO ED BY CITY OF EVERETT PUBLIC WOHKS <br /> J r-C LOCAL SALES <br /> nA,E � � �y � TAX COOE IS 3105 roTn� _ <br />