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APPLICATI�r�I FOR CONSTRUC'i.�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> S <br /> � HEATING SYSTEM: U GAS ❑EllSCTRIC U_____-- 1 <br /> � BUILDING DEPARTMENT <br /> � 259•B&10 <br /> , I DEMOLITION COMBINATION BUILDING MECHANICAL LUMBING SIGN <br /> � �R MMl�DDRESS GpY ZIP PNONE �' p f C S <br /> ? Kl�c�sf�- V� ��t_cU�CcY J :s 3y I ,u` r aS r �� <; � �A ,'nF, " �C��1-lG�� <br /> � TEN�NT M�IL�OORESS dTY IIP P1qNE <br /> ARGNItECi OP OESIGNER M�I�ADORE55 dTY ZIP PIqNE <br /> OENERAI CONTRACTOR M�IL�DORESfi CITY ZIP P110NE ST�TE UCENSE� <br /> MEGNIINICQCONTRACTOR M�ILADORE55 G7Y IIP PNONE SU7ELICENSE� <br /> PLUMBIN6UMliR�CTOR M�ILhDDFE55 C�TY 21P PHONE 6TAIELICENSF� <br /> '• 1, l ♦ <br /> � ��VVN�'.-YC_ __ _. <br /> CUSS OF WONK <br /> I 1 NEW i ! ADDIT�ON � �� ALTERATION r�EPAIR DEMOLITION � WOODSTOVE/FRPL INSEHT �� BUILDING RELOCATION <br /> CANUCT PENYkI AND PHONE NO <br /> CONTRACT PRICE OF WOi1N –__ <br /> UESCRIdE WORK�ND SOUARE FOOT�GE IIIVOLVED <br /> PIqPO5ED115EOF0UILDINO i HEREBV CERTIFV THAT I HAVE REAO AND E%AMINEO THIS <br /> � �� - [�,r APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> LE011L DESCRIPTIONOF PROVEIIiY 15NOWN OELOW OR�TT�CH FMIR COPIE5� PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS iVPE OF <br /> WORK WILL BE COMPLETEU WITH WHETHER SPECIF�ED HEREIN OR <br /> tor BLOCN _ OF NOT. THE GRANTIIJG OF /� PERMIT DOES NOT PFESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATINC CONSTFlUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION. Th,'.. i AM AUTHORIZED BY THE <br /> OWNER OF THIS PR�PERTV TO PEFFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTO S LAW 1827 RCW AND 296.200 WAC. <br /> �+ X �� i-3i - 9�2 <br /> I v�aEcr�ooness � I �ui� � �iu c:. •��� °"�F <br /> I �� G1 C �i . C ^��� /J� CItYBU5ME55liCEN5E1q <br /> • ` <br /> i PLUMBINO MECHANICAL <br /> � � NO. TYPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> + WATER CLOSET(TOILET) _ A/C—NHNDLG UNITS—H.P _ � <br /> I BATHTUB _ FORCED AIR SVSTEMS—B.T.U. M E.A. ; <br /> , LAVATORV(WASH BASIN) _ __ UNIT HEATERS—B.T.U. M <br /> � SHr,WER � CLOTHES DRVERS � <br /> KffCl IEN SINK d DISP VENTILATION FAN i <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRV TRAV ; WATER HtATER ' <br /> � CLOTHES W45HEN � WOOD STOVE _ <br /> I URINAL ' METAL FIREPLACE 8 CHIMNEV ' _ <br /> I DR�NKING FOL'NTAIN FIREPLACE INSERT ' <br /> I -- _ —�. <br /> FIWR DRAI�: HEAT PUMP � <br /> + �ACKFLO':�PREVENTERS ;� GAS PIP�PlG _ <br /> � ROOF DRAINS—FIAINLEADERS � EXHAUST FAN <br /> � SINK(SERVICE--BAR.ETQ) �' <br /> � i <br /> � <br /> ! — �_ — <br /> � —._— ' <br /> � SUB TOTAL S �-' SUB TOTAL S J__ <br /> + PERMIT S � PERMIT S <br /> j �— — ---' <br /> p TOTALFEE S r" TOTALFEE S <br /> j FOfl OFFICE USE ONLV: <br /> � FRONT 6EiBACK RE�P SETB�CN SIDE SETBACM PIRN CHECK NUMpI R FEE FELEIPT NO <br /> � � <br /> � U9E IONE lOT AREA vnceNr sir� FEES VALUATION FEE <br /> _T— <br /> BUILDING <br /> � tYYEOftONfS�IIOW�BtE iYPfdCONS71�tillAl acivu1a xoaow[wraax:�s <br /> - cewa PI.UMBING <br /> �-- <br /> SiZE OF BLOl3 NO OF 6TORIES IIASF.MENT MECNANICAL � <br /> OCCUPANCV I.OAO FAE SPRNXLERS REO'P NEIOH7 UMII l TION ADDITIONAI PUN GHECK i <br /> ___ SPRINKLER <br /> � REASON FOR SPNINNLEPS — <br /> STATE 6UILDM�SUqCHRRGf. <br /> iNieN!PV i'UNS�PPROVEDBY g�Ty pF EVERETT PIIBLIC WORKS i <br /> LOLAL SALES 'T— <br /> � TAX f,ODEIS 3705 ror�� <br />