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APPLICATIO�: FOR CONSTRUCTI N! PERMIT � <br /> TO BE COMP�ETED IN BLACK INK—PLEASE PRINT <br /> --------- <br /> — <br /> f HEATING SYSTEM: J�AS J ELECTR�C J _—_. -- --- <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION COMBINATION � BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MRil�00RE55 CIjM 2i� P��ONF <br /> T/�c� f?d(�,v,: Qfi �7U f,('�' 37d7 /�w/50=� `/2 �i:q,'Tiif, l✓P . yr�.�2v r',rc —� r-��' <br /> TENANi MRit RUDRE55 LITV Zi� PNONE <br /> �jli ./JL • _ <br /> AfICHTEf,iORpE51GNEf{ MAIL�ODRE55 CITY Zlf' PNONE <br /> `� . <br /> vs -r,,,� ,� . <br /> GFNGFLLCONiRACTOR MMIApDNE55 CI1Y ZIP PHONE STQELIGENSE� <br /> ME[NpNIC�LCONiNACTON MMI�ODNE55 CITY TIP PNONE STRiEIIGENSE� <br /> PWMBINOCONiR�CTON M�ILn�ONELS CITY ZiP PNONE ST�iELIGENSE� <br /> CpNTq�GiPRICEOFWORM ^ <br /> 0 0 � uoo _ <br /> �ESCRIBE WORN�Np SOU�RE FOOTAGE'NVOIVED LONi�GT 1'ERSON�N�PHONE NO <br /> � � �`f <br /> 1-Eu rip n %' , 7-�.,�',oi•_� t l . 6 C '� <br /> R.EI'I:2ftN �� �F"��GE i H[PEBV CFRTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PFOPOSE�USE Oi BUILNNG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TYPE OF <br /> ICGAlDESGFiPiIONOFPROPERTVISNOWNBE�OWORATTRCHTWOCOPIE51 NO? THELGRAN ONG OF AD ERMITJDOES NOT PRESUMEEtO GIOVE <br /> ior e�xK ov AUTHORITV TO VIOLATE OR CANCEL THE PFOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 1HE <br /> PERFORMANCE OF�ONSTRUCTION.7HAT I AM AUTHORI2ED BV THE <br /> nWNER OF THIS PROPERTY TO PERFORM THE WOf7K FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WI1H THE STATE <br /> P�RCEI i�M I D NUAIBER CONTFiACTORS LAW 1827 RCW AND 296200 WAC <br /> GONSTRUCTIONIO�NIENDER,A0�RE55.TElEPHONENOMBER /� /_� [/ /t //�/cj )� -- <br /> `� i��� ✓( -� <br /> s�cv+�w neq <br /> PROJECT ADD9ESS �J - <br /> � L^J/ C /¢.S/N<^ ��• T J ^��C unnusiNtssin:nn� r�o <br /> CfCJ_� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N�' A;�_A�HND G NF SOUH M ENT <br /> FEE <br /> WATER CLOSET�'OILET� <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> ----�— <br /> SHOWER CIQTHESDAYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHW 15HER � <br /> RANGEHOOD <br /> LAUNDRV TRAV ' WATEFi HEATEH <br /> CLOTHES WASHER � WOODSTOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' . <br /> URINAL <br /> DfiINKING FOUNTAIN FIREPLACE INSERi <br />� FLOOR DRAM � HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS El(HAUST FAN <br />� SINK(SERVICE—BAR,ETG) <br /> � <br /> � <br /> SU9 T07AL E SUB TOTAL S _ <br /> PERMIT $ __ PERMIT $ <br /> TOTAL FEE $ TOTA�.FEE $ __ <br /> FOR OFFICE USE ONLY: — Recemr No <br /> PLANC��ECN OMPFR FEE <br /> FRONTSF.TBACN RE�RSETAACM SIDfSFiBACN �/f� <br /> 1 <br /> USE Zd1E lOT�RE� V�GAN!SITE <br /> FEES VALUATION FEE <br /> ��S N� BUILDING �O, J`�� ��_��SZ' <br /> NOo�STORiES rv�� " e�Mnwfii�r��m��s --- � <br /> ivr at rcae5� pWMBWG ' <br /> �_ � D -'t ' <br /> SIZE OF QBIUG FIRE S'yPP/INNlERS REO'D B�SEMENt MECHANICAL -- <br /> I� V�� / �s . VES �� <br /> ADDITIONAL PLAN CHECK <br /> OCCUPANLVIOpD Fl F l4RMRf.QO NE�GHTLIMIi�"'ON ; <br /> ' J �'�5 _ OTHER _ <br /> REASON ��1 f�� STATE BUILOING SURCNARGE ��� <br /> INi�nF.B� PLANS PAOVE�BV CITY OF EVERETT� ruouc woAKs <br /> j hM LOCAL SALES <br /> ���E �z -I ?-1 � <br /> TAX CODE IS 3105 rou� <br />