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APPLICATIO i FOR CONSTRUCT.'W1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �EATING SYSTEM: J GAS 'J ELECTRIC .J _ ____ _ -� <br /> 259•8810 <br /> I I DEMOLITION COMBINATION �( BUILDING I.I MECHANICAL C I PLUMBING I I SIGN <br /> OWNER MALLAOONE55 U:v ZiP P�i01�[ <br /> TN�� I3�EiN6 ��� f?�• 6a� �7o�� � sCF�-/3Sc.rqrr�;G�A- 9��Ly <br /> iENANi MRRAD�RE S Cilv zIP ~ P��ONE <br /> �o�l N6 - <br /> AR RECiOR0E51GNEN MAILRDONE55 LILY ZIP PIIONE <br /> �O 1.��/�G• <br /> G/�HENRICONiRACTOR MMlA0�RE55 GTV ZIP PMON[ S1ATElICENSEI <br /> ('I U5'r!1� ' <br /> 4ECNANICAL CONTPAGIOR IAML pDOBE55 CIiY 21P PNONE STRiE LICENSE I <br /> PIUMBING CONTR�GTOR MAIL��DRESS CIiY ZIP PHONE STRiE LICENSE I <br /> CONTRALT PRILE OF WORN <br /> Od� � �V <br /> OE �9 ylfl Ij D y°Qtl/�({EV�A�IN VE �I M I G [ONiRCi PERSON A4p PHONE NO � <br /> (�G/[./t• O ft <br /> ��(lNQ-2� � �• NgU/V.SK.� �6���1 �� <br /> I HEFEBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> �qOPO5EDU5E OF BUIlOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PFiOVIS10NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRlDESCRIPTIONOFPROPERTV�5110WHdELOWORRTiRCMT\VOCOPIESI WORK WILL BE COMPLETED WITH WHETHEFi SPECIFIED HEREIN OR <br /> NOT TNE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE <br /> �or e�ocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTION OR THE <br /> ---" PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> — APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> P�RCEI TR%I p NUMBER CONTRACiORS LAW 7827 RCW AND 296200 WAC. <br /> CONSTRUCTI lLO�NIENDER �DpflE55.TElEPNONENUM R -/ <br /> � s,Nv 2, �(�—��— � ���1�-�'�' YI'/6 /S' <br /> PROJECT ADDRESS sr.r�nune -- oerz <br /> crtrousnrtssnov�i uo ' <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FII(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WA7ER CLOSET(TOILET) NC—NHNOLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATERHEATER <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRIIJKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> —r— <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DFAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> T <br /> SUB TOTAL $ SUB T9TAL 3 <br /> PERMIT $ PERMIT $ <br /> 70TALFEE 5 TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBAGN RE�HSETDAf.N SIpESETOFCN PIANCH CNNUMBER GEE RECEIPLNO <br /> '" �"'L <br /> use zone lOT RNFA vncaNr sire FEES VALUATION FEE <br /> � YES - NO BwLDING p 0 o Op0 <br /> IVPEOfGON51 NOOFSi0RIE5 �Kccu'n:. •,'�np�w�.i�4�.i•,�t — � <br /> °P�''� PLUMBING ' <br /> L'-- —�- � <br /> SREOFOIOG FlPESPRiNNlEP5RE0D B/.SEMENi M[CHANICAL <br /> ,.i n c, �S YFS ./�O — — <br /> J-L-i� AO�ITIONAL PLAN CMECN <br /> C�GUP�NCYLCRD FiREAl�R/R1AR[OD HEIGHTLIMITATION <br /> OJ /ES __ OTHEF <br /> RERSON —---�— <br /> �� (.r L STATE BUILDING Sl1RCHARG[ _ i <br /> J '1 � <br /> INiANE BY vur+s an oveu ov CITY OF EVERETT PU��IC WORKS ' <br /> �Il, LOCAL SALES � <br /> „A,� , � _ q TAR CODE IS 3105 TOTAL ' <br /> �� <br />