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�tioq 5 <br /> APPLICATIQ"' FO�t CONSTRUCT''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS J ELECTRIC J —� <br /> 259-8810 <br /> ' DEMOUTION COMBINATION BUILOING �'AAECHANICAL PLUMBING SIGN <br /> OWNER M�il q0�RE55 CItV z�p p��(]f�E -- <br /> ��n Lvors �4/6 Cleorl,�,i /Wc �✓�e�y 9820 ( 339-�3s 9 <br /> TENANT—� M�iL�UpRESS GTV IIP PHONE � <br /> �RGUTEGT OR DESiGNER M�R FDDRE55 GTY ZIP PrqNE <br /> GENER�L GONTRIICTOR M�IL�ODRE55 CITV ZIP PNONE 5T4TE LICENS <br /> �,� Gaidrn ����.,.., � 2s�-6��q � M �-- <br /> MECH�NIC�I CONTN�CiOP MAIL�DDRE55 CITv ZIP pNONE SUTE LICENSE� �� <br /> PlUM81NG CONTR�CTOR M�II�D�RESS CRV ZIP PHpHE ST11TE LI�ENSE/ <br /> O �� <br /> CONTR�LT PRiCE OF WORK — <br /> DESGRIBE WORR�ND SIXURE FOOT�GE INVOLVEO CONTACT PEPSON�ND PHONE NO <br /> IAS��(� L :A sf • <br /> l/���- �✓��' r� Q i HEREBY CERTIFV THAT 1 HAVE READ AND E%AMINED TI�IS <br /> PNOP�olyse.p�BUIl01NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> I— l� PROVISIONS OF lAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LE6�LDESCRIP7�ONOFPROPERiY�5N0MMBELOWORQUCHTWOGOPIE51 WORK WILL BE COMPIETED WITH WHETHER SPECIPIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT BLOCK--_ OF AUTHORITV TO VIOLATE OA CANCEL THE PROVISIONS OF ANV <br /> OTHEH STATE Ofi LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIIED BV THE <br /> OWNER OF THIS PFOPERTY TO PERFORM T'1E WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> VM,CEI T�%10 NUMBER CONTRACTORS LAW iB.27 RCW AND 296.200 WAC <br /> C STRUCTION LO�N lEN ER.�DDRE 5.TELF.PNOHE NU BER <br /> �1�,..� l �✓�o.t S ��— <br /> P ECTA DRE9S �v��unr nut <br /> Ci1Y0'�SMf551�LfNS1 NO <br /> PLUMBINO MECHANICAI <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—AiHNDLG UNITS—H.P. <br /> � OATHTUB FORCEDAIRSVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> . SHOWEH CLOTHES DRVERS � <br /> KITCHEN SINK R DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> � LAUNDRYTRAV ; WA7EF HEATER <br />� CLOTHES WASHER � W000 STOVE <br /> URINAI METAL FIREPLACE(WOOD BURNINQ) <br /> DRINNING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PHEVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � � <br /> � <br /> � <br /> 0 <br /> SUB TOTAL E SUB TOTAL E <br /> PERMIT S PERMIT S �OU <br /> TOTAL FEE S ' TO7AL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONi5ET8�C1t RERRSETB�f,k SIOEFETB�CN PI�NGHECItNUMBER FEE ��.ECEIPTNO <br /> usetorre LOTARE� WCANTSITE FF.ES VALUATION FEE <br /> ; � VES � �� NO BUaDMG <br /> IYPEOfCONSI NOOF^ufORIES nttimucv NOMtMxuxcux��5 � <br /> c9°°� pLUM01NG <br /> SIIE OF B�O6 fIRE SPRINHLERS PEO'D B�SEMENT MECHANIGAL <br /> �� ves rio <br /> �� OCCUP�NCV LOAO FlRE�L�RM REOD HEIGHT LIMItATION ADDITIONAI PLAN CHECK <br /> OTNER <br /> REASON <br /> � STATE BUILDING SURCHARGE <br /> INt�hE Bv R�NS�PPROVEO BY CITY OF EVERETT PUBLIC WOHNS <br /> LOCAL SALES <br /> �„rE TAX CODE IS 3105 rou� <br />