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APPLICATIO.. FOR CONSTRUCTf �N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> �� <br /> BUILDINGDEPARTMENT 1 HEATINGSYSlEM: JGAS JELECTRIC J ___ _______ _] <br /> 259�8810 �C��L�CvX��v n �� J�//U�' /85�' ?�C. 9�/5� ��GS�/U17 <br /> DEMOLITION COMBIN 10� BUILDING MECHANICA� PLUMBING ✓SIGN <br /> O-WCNF.R � M�II�DDRESS �1 CitV ]iP PNONE y� 1 7 y./_ p <br /> _��- . � �gt".,�e�nitr � .���_��S�✓iG /�t7 ( ✓P✓�P�1 �C�C�� <br /> iENAI{� MRIL�RDDRES��� 21P P40NE <br /> 0.J <br /> ARf.Ni1kCTORpESIGNEn MRIL�ppRE55 CITY ZIP PHONE <br /> 6ENER�I CONTRRCTOp MRII ADDRE55 7 ^' (ItV IIP PNONE `piE LI E SE{� M � <br /> �mr.M1 I �J /� t �/� � .�l��oc �'�4 c:.���;`�P <br /> p 'Irrn� /�d� ��7 �� /'"/u�ic:�ru �r ,lw:r St: <br /> MFC ANICAICONiRACTOq MAII�D[1FE55 CiiV � IP PHON^_ 51���Sh.r�<< F� <br /> �� �9 U�_'7 i7.fJ <br /> PWMBINGCONTRALTON M�ILqODNLSS GLY piP PMONE 57�tElICENSEf <br /> CONIRRCT PRICE OF WpqK — —'---� <br /> /l,c.3n . '- <br /> DESCRIBE WORN�ND SOUABE FOOTp6E INVOIVE� CONiACi PERSON AN�PHONE NB <br /> a��� X ��- � ��� _ � �,��,,, s6r - ���-�— <br /> WM/ 5�'� r� _ \�a�r,�_ < k'w. 235== s <br /> --�` —�-�--- <br /> i HE9EEV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PN(O�PO�SEp USE OF BUILDING APPUCATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT ALL <br /> J YYfi�i� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecaoElS.eirnoNOFvnove iVISNOWNBEIOWORATI�CI1iW0[OPIESI WORK WILL BE COMPLETED WITH WHETHEP SPEGFIED HEREIN OR <br /> �or eiocK or NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> _ OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFOFIAIANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPE9TV TO PERFORM THE WORK FOR WHICH <br /> PAqCEI t�r 10 NIIMBER <br /> --- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 295200 WAC. <br /> LONS�PUCTIONIO�N:ENDER.A�ORE55 TELFPNONENIIMBER � <br /> �'l1 � i I �/ <br /> PROJECT A,D^DR�E-SSL s�rr.unu — ���E <br /> � �[�l C ; �JerE-H' 3'V ri�vn�isr��tisi�:tNe w� — - <br /> PLUMBIN6 MECIIANIChL <br /> NO. TYPE OF FUfTUHE OR ITEM FEE NO. TVPE OF EOUIPMENT PEE <br /> WATER CLOSET�TCILET) A'C—AHNDLu UNiTS—H.P. <br /> BATHTUB FORCEU Alq SYSTEMS—B.T.U. M E.A, <br /> L4VATORV(W45H BASN; UNIT NGITERS—B.T U. M <br /> _ SHOWER CLOTHES ORVERS �— <br /> KITCHEN SINK 8 DISP VENTILAT1�N FAN <br /> pISHWASHFR RANGE HOOD —T <br /> LAUNDRYTRAV WATER HEA�'ER <br /> CLOTHES WASHER K'!�D STOVB � <br /> URINAL METAL FIREPLACE�WOOD BURNING) <br /> _ DRINKING FOUNTAIN FIflEPLACE IN5ERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS _ GAS PIPING <br /> _ ROOFDRAINS—�AINLEADERS EXHAUS�FAN � <br /> _ SINH(SERVICE—BAR. ETC.) � I <br /> — _ _— T-. <br /> SUB TOTAL 5 SUB TOTAL $ <br /> PFFMIT $ PERMII $ <br /> TOTALFEE $ TOTAL�EE $ <br /> FOF OFFICE USE ONLY: .r°LEC 4',37L'� <br /> fRONiSETBACN .ARSF.TpPC SIOESEId�CN P�ANO�CCNNLlA1AFR iFE RFCEIP N <br /> S/ H' ��� 3 � 1 Z2. 7.> ��_`J <br /> usem e �otnaen VRCRNi511E FEES VALUATION FEE <br /> '� VES � NO BWLDING � ' <br /> ���'f41CON9 NOO�SroRiF6 r�1,�eµc. nnaow[u�xr,ih��s -- — - —���-- <br /> r�umiP p�UM81NG <br /> — __T—. <br /> SIIEOFBIDG cIPESPRINvlER5RE0'P B�SEMENi MECHANICAL <br /> VES NO — _ <br /> III:f.I1V4NCYl0�0 FIqEAUf1MFEOD IIEIGIRIIM!TRTION AODITIONALPLANCHECK � � <br /> OTHFR <br /> fiF 450N <br /> __ <br /> S7ATE BUIIDING SURCNARGE ' <br /> _ . ______ —____—_—'_. ._ .—_ ' _. _L, <br /> �N�nrt R� auNs nrv�nnvl n m CIiY OF EVERETT vuni ic woFKS <br /> �M LOCAL SALES <br /> n��� ( � TAR CODE IS 3105 tOTAL � ��2� <br />