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APPLICATIC 1 FOR CONSTRUCT�IN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC ❑ � <br /> 259-8810 <br /> ❑ DEMOLITION I 1 COMBINATION I i BUILDING I 1 MECHANICAL : I PLUMBING I I SIGN <br /> �,r'i � �;"r'�P°7;55 ub2 �I�v�l�"�,P c��0( Po�Sa_a91�1 <br /> TENANT M�IL�DDRESS GTY ZIP PHONE <br /> ARCHITECiOROESqNEH IA�R�DGRE55 piY ZIP PNONE <br /> OENER�L CONTRACTOR M�IL�OURE55 dTY IIP P/IONE Si�iE LICENSE• <br /> �� Cl�� <br /> MFCHANIGLL CON RAGTOR M�II�DDRESS QTV ZIP PNONE ST�TE LILENSE� <br /> PLUMBINp GONTR�GTOR M�IL�DDRESS CITY ZIP PHQ.: ST�TE LICENSE� <br />� � C �CTP C WORN ^ <br /> U <br /> DE BE WOR �N gpU�pE FOOT�6E 1NVOlVED CONT�CT PERSON�ND PNONE NO <br /> V r � <br />� I HEREBV CERTIFV THAT I HAVE REAO AND EXAMINED THIS <br />� pnorose u� aort+a APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORD�NANCES�OVERNING THIS TVPE OF <br />�. iea�i�T OF PNOPERTV�GN�QI�Y/1"ae�owo/g'�iTACbNryI/�1 eor si/ WORK WILL BE COMPLETED WI?H WHETHER SPECIFIED HEREIN OR <br /> �or eice� —� oF ` �pl='��i 1-� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OH LOCAL U1W REGULATIN6 CONSTRUCTION OR THE <br /> . PERFORMANCE OF CONSTflUCTION.THAT I AM AUTHOflIZED BV THE <br /> OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br /> .4PPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEL TAX ID.NVMBER CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> � T TIONlO iLENUER.�O RESS,T EPH I NUMBPJr <br /> ��5� '.�te�R���- C✓ ,� �.- �17-�3 <br /> ECT DDIIE 8 sr,eet rz oe <br /> rnv ein.rc ss ic�Mss rn <br /> , p���p MECHANICAL ', <br /> � Np, TYPE OF FlIITURE OR ITCM FEE NO. TYPE OF EOUIPMENT FEE I, <br /> � WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. � ', <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' I <br /> �� LAVATORV(WASH BPSIN) � UNIT HEATERS—B.T.U. M ' 'I <br /> SHOWER ' CLOTH�S DRVERS 'I <br /> KITCHEN�!NK 8 DISP � ; VFNTILATION FAN ; ', <br /> � DISHWA:iHER � RANGE HOOD � I <br /> LAUNDRY TRAY ; WATER HEAiER ' � <br /> CIOTHES WASHER � WOOD STOVE � <br /> URINAI ' METAL FIREPLACE(WOOD BUHNINO) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT I i <br /> FLOOR DRAIN � HEAT PUMP ' i <br /> BACKFLOW PREVENTERS ; I GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � � <br /> SINK(SERVICE--BAR,ETC.) ; � <br /> � � <br /> � � <br /> SUBTOTAL S ' SUBTOTAL S 'OG <br /> PERMIT S PERMIT E �O <br /> TOTAL FEE S ' TOTAI FEE $ ' O <br /> FOR OFFICE USE ONLY: <br /> LRONTSETB�CK RE�RSETB�CN 61DESETBACN PLANCNECRNUMBER FEE RECEIPiNO <br /> useza+e LOi�RE� V�C�NT6ITE FEE9 VALUATION FEE <br /> C1 VES fl NO BUILDINO ' <br /> trrtacoxsr raasronies «cw.�� xoa�w�u�ns — � <br /> �nwv p�UMBINO i <br /> BITE Oi BIMi. FIRE SPRINNlERS NEOU B�SEMENT MECHANICAL � <br /> � ves n No <br /> OCCUPANCY LO�D FIRE�L�HM BCO'0 MEIOHT tIMIGTION ADDITIONAL PUN CHECK � <br /> � <br /> OTHER � <br /> REA60N STATE 9UILDIN4 SURCH�ROE � <br /> INL�NE BV PLANS�PPNOVED BV CITY Of EVERETT PUBLIC WORNS � <br /> LOCAL SALES <br /> o,,,E TAII CODE 18 3105 ror�� <br />