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��d9����PPLICATIf� FOR CONSTRUCT+�lN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> ����''� <br /> HEATIN�i SYSTEM: U GAS U F.LECTFIC ❑ ni�r�i ..,�- <br /> BUILDING DEPARTM[NT ,_ <br /> 259-8810 Pu!,lic l'✓orb.s Dcpt. <br /> [ DF.lAOLITION ; i COMBINA110N I i BUILDING I I MECHANICAL i'�PLUMBING f i SIGN <br /> OWNE MRII�ODRErSS /� GiY 21P PNONE /, _y._ / <br /> J�,�> S'v'Y�v�naCc�A\. 1'4-�� �In��.c' �c e �Q� 1�.; r'roC � nri I�r1 f ' �/ 1 �U -5�>3 ,' <br /> TEN�NT M�R�OORE55 CITY 21P PHONE <br /> �RCHITEGTORDESIONEH MIIR�DDRESS CITY ZIP P1N1NE <br /> _ � <br /> PENER�ICONTR�CTOR M�I��pORE55 CITY IIP P110NE STATELn:ENSE� <br /> MECN�NICAI GONTR�CTJR MML�DDRESS GiV ZIP P410NE 5U7E IiCENSE� <br /> PLUMBINOCOMTRAC70R MIIILAD�RE55 CITY IIP PNq1E '9TATElICENSE� . <br /> _� 1� <br /> � t%t������� �_�.�nc�fc.��r. �C? ��' l � l u � � (I. f. � c 1 ��� � i. <br /> �� � �--1„� o- <,�� — �' _ i � . 1� l�- _AK�-_s�t�>>aon <br /> CONTR�CT PRICE OF WORN <br /> DESCRIBE WORk I1NU SOU�RE f00U0E IIIVOLVED CONT�CT PERSON AI.D PHONE NO <br /> �,��,��_ ���,����Cl�_. U�. �,.- z" �4'�� '� (;��; �� ���r��r���t �7�t� )� 3�� <br /> Cf� 'n�-�J+^ C���:'cA. 1��_ i HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PPOPoSE IISE OF BUILUINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TVPE OF <br /> LE��LOESCRIP710NOFPNOPERiY15NOWHBELOWOR�iT�CNTWOGOi'IES� WOHK WILL BE COMPLETED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT- e�ocK oF AUTHORITV TO VIOIATE OC CANCEL THE PHOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULhTING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEP OF THIS PAOPERTV TO PERfORM THE WORK FOR WHICH <br /> — APPLICATIQN IS MADE AND I COMPLV WITH THE STATE <br /> P�RLEL TAz 1 D NOMBEN CONTRACTORS LAW 1827 RCW ANU 296.200 WAC. <br /> CONSTRUCTIONIO�NIENDER,�D�RE55.iElEPHONE NUMBER <br /> � � <br /> xL ���__r���c���.A 5�!!�3 <br /> PROJECT AD9RES3 s�r��w�a � � out <br /> � �a � �n ��,.a� , �,s K��s„�� — <br /> .'�'z]3 W . C a'.>> Nc: �h',i�. \� t1 c R- <br /> PLUMBIN� MECNANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC--A/HNDLG UNITS—HP. <br /> BAiHTUB FORCEDAIRSVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BAS�N) � UNI7 HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD —�— <br /> LAUNDRYTRAY WATER HEATER <br /> CIOTHES WASHER WOOD STOVE � <br /> URIYAL METAL FIREPLACE(WOOD BURNING) <br /> DFINKING FOUNTAIN � FIFEPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTEHS �/jtJ GAS PIPING <br /> ROOF ORAINS—RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAS,ETC.) ; I <br /> _ <br /> — <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S ' �dZJ PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: __ <br /> FRONISETB�CK NE�RSF.IDACK SIOESETB�CN Pl�NC1ECNNUMPEF FEE RECEIPTNO <br /> O <br /> use za+e l0T RRE� WC�NT SITL FEES VALUATION FEE <br /> ; 1 VES ( 1 NO BuaDMc <br /> fYPEIXCON51 NOOFSi0i11E5 atowxcv MowvMua,ux��s — —� <br /> G90.j0 PWMBING ' <br /> T <br /> SREOFBL00 FIRESPA�NKIERSREO'D B�SEMGN7 MECNANICAI 1 <br /> I 1 VES �"i NO - <br /> OCCUP/JICY LO�D fIRE AL�RM REOU HEIGIR IIMIi�fION ADDITIONAL PLAN CHECN � <br /> i <br /> _ OTMER � <br /> REASON --�— <br /> STATE BUILDING SURCfiA{iGE i <br /> i <br /> i41rNE 0� �UNS�PPROVEDBV CITY OF EVERETT PUBLIC WOflKS <br /> LOCAL SALES --� <br /> o�.E TAX CODE IS 3105 TOT�L <br /> � <br />