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APPLICATIC�f FOR CONSTRUCT`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPAR�MENT � HFATING SVSTEM: ' GAS i.J EL�CTRIC i,.] <br /> 259-8810 / <br /> I 7 DEMOLIPJN � ! COMBINATION IY� BUILDING � I MECHANICAL I ':PLUMBING f I SIGN <br /> OWNER MN��ODRESS dTv ZIP pMOryE <br /> K�Rr Pc £�N�A�r_2 Lt3o cEDAe S% r=v a.�Tr WA. 252. 8v73 <br /> Teruur M�IL���RESS �iT. <br /> Z�P PNONE <br /> ARCNITECTOPDe510NER MML�DDRESS CIiV pIP p�E <br /> GENER�LCONTR�CTOP M�IL���NESS CITI 21P PHONE S1�TELIGEN5E� I <br /> GAe-r�oN coNsr &�Y maa�NL D2 n,ha,+Sv,��t, w�F. 5ta�� �s93Fr�") 6A��vaa �Fhocv� ! <br /> YEGHMlIGQ CONTR�G70R MMl�ODRE55 �ITY ZIV PHONE SUTE LICENSE� 'I <br /> VLUMBINQCd1TqAGiOR MML�DORE55 GItV IIP PHOHE SUTE LICENSE t <br /> CONTR�CT PRICE OF W�RIt <br /> _ �/� /Oa � <br /> DESCRIBE V/ORN�NO SWARE FOOTAQE MVOIVED CONT�CT PERSOj�ND PHONE <br /> s� rr �°/��Nanl 655-?S7� <br /> AD 2y2 � F+. �EJ�o �+ 'r'o <br /> 2uD a , O f ��n£� � HEREBV CERTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> GROPOSED�eqa2uaonic APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> F _ _ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LE(3ALOESCRIPlqNOFPROPEPTY�SHOWNNiLOWiiqATUCMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEqEIN OR <br /> �or e�ocK � NOT. THE GRANTING 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 /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK fOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE S7ATE <br /> P�RCEL T�%i D NU ER CONTRACTORS LAW 1B21 RCW AND 296200 WAC. <br /> � � �UQS <br /> CONSTN Tr L �NLENDER.ADDRESS.TELEPNONE NUTABER <br /> s-z3-Ss <br /> PNOJE TADDRE3.�/� src:nuunF o��i <br /> � �� G��YIIUq�NF9511fifNSF1A <br /> � PWMlINO MECHANICAL <br /> NO. TYPE OF FlI(TURE OR ITEM FEE NO. TYPE Of EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. <br /> / BhTHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWEF CLOTHESDRVERS —�— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER qANGE HOOD T— <br /> LAUNORV TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL METAL FIREPLACE(WOOD BUFNING) —~ <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOF DHAIN HEAT PUMP T- <br /> —;--- <br /> BACHFLOW PREVENTERS ; GAS PIPINO � <br /> ROOF DRAINS—RAINLEADERS � F.XHAUST FAN T <br /> SINK(SERVICE—BAH,ETC.) �— <br /> ' � <br /> � � <br /> � <br /> � <br /> SUD TOTAL E SUB TOTAL S <br /> PERMIT � PERMIT y <br /> TOTALFEE $ TOTALFEE S � <br /> FOR OFFICE USE ONLV:�_ �Z- <br /> FRONTSETBAL� RE�PSET�CN SIDESEiB'��i PL�NCfEGNN�BER FEE / ^� REC �NO <br /> UV ll C�� Y .YO <br /> use icrene� WC�NTSRE FEES VALUATION FEE <br /> �-Z �'� f l VES � O pUILDING 'n\ <br /> lYYEOf[ I OFSTOqiES occuawcr qaamn«ixcuxns � � � vv <br /> � ' PLUMBINO ��(f <br /> SREOFBLDO FIRES�PINKIERSREO'D B�SEMENi � / MECHANICAL i <br /> Z SP Cl VES �Y"NO <br /> IX:CUPANCY LO�O FIPE Q�NM EOD MEIQHT LIMITATI(1N �DDIiIONAL PUN CNECK � <br /> � , <br /> OTHEq i <br /> REASON � <br /> � <br /> STRTE BUILDINO SUfiCNAqGE L� <br /> i` <br /> INT�MfBY PUNS�PPROVEDBV � <br /> CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL BALES ' <br /> DATE �e 4p TAK CODE 18 3105 ror�� ,�-�- <br /> �S� • 5� <br />