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� � v APPLICATIG.1 FOR �QNSTRUC? JN PERMIT <br /> TO BE COMPLETED IN BLhCK IkK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS 0 ELECTRIC [J <br /> 259•8810 <br /> I I DEMOLITION I I COMBINATION �BUILDING I I MECHANICAL i I PLUMBIN(i I I SIGN <br /> OWNEP MAIL�DOPESS <br /> CI7Y 21P p�E <br /> _TNE �rN< Go. P o aoX 37Q7 M/S coF -76. ScS/1-71'GE ' N 9 z 93 p <br /> TENANT M�IL DRE55 �` �� P���* " �( � ��2' �/ <br /> S�m� /� or.�,v�ir. <br /> �RCNITECTOqDE51Ory;R MI1IL�UDRES CI7Y Z�p P�qNE --�-- <br /> 6u�f� M� �ou✓�u. �o a�k ��9173 ��,s,«s c�ry Mo. 6yi,�/ C8/6)333 -Y37S <br /> 6E MICONiRACTOR MIIRMD ESS �Y Ilp PNONE <br /> ?• 6 UTE LICENSE/ <br /> �-�+r�}' • ,��J - �.� ��� �!'F �-�-,�..�. 9'yoo 7 fl.�_ �o e 6 <br /> MECNNIIC�LCpryYpI1�TCP MI1IL�DDRESS CIiV =IP <br /> ��� Bi11TElICENSEI <br /> .���5 CS //O .f/� <br /> FLUMBMOCONTMCTOR MAILMORESS ��t� Z�P P�E <br /> SI�TE Lr,kNSE� <br /> �C SS OF Wpql( <br /> NEW i I ADDITION I� I ALTERATION I I REPAIR I I DEMOLITION i I WOpDSTOVEiFRPIINSERT I I BUILDINGRELOCATION <br /> CdIT�CT PERSOH�ND MqNE N0. — <br /> GONTIUCTPRIGEOFWIXII( 4�i OQQ _ L:Lro�vR��,p G.r1+1QO�Sk./ 2GH_3rL3 <br /> DESCRIBE MIOBN�ND BOU�RE FOOI�OE VrxVEO - <br /> 2 ,c y o= 9(oc+ SF <br /> P�W'45EOUSEOFBUROPq i HEREBY CEFlTIFY THAT I HAVE READ AND E%AMINED THIS <br /> Ol_ S APPLICATION AND KNOW THE SAME TO BE TpUE AND CORRECT.ALL <br /> LE04LOE60RIPTqNpFPlppEflTY�611UYMBGLOWOR�TT4CHFWRCpPIE6� PROVISIONSOFLAWSANDORDINANCESOOVEHNINOTHISTYPEOF <br /> �or. e�ocn �M WORI( WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR <br /> ' NOT. TFIE 6RANTINO OF A PERMIT DOES NOT PRESUTAE TO 61VE <br /> AUTHORIiY TO VIOLATE OR CANCEL THE PflOVISIONS OF ANY <br /> OtHER STAtE OR LOCAL LAW REOULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.T�1AT I AM AUTHOF12E0 BY THE <br /> OWNER OF THIS PROPERTv TO PERFORM THE WORK FOR WHICH <br /> —' APPLICATION IS MADF AND I COMPLV WITH THE STATE <br /> . CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ' vnaecrnooness — s� � = ��'��1 G�/G �9.� I <br /> �� r o 2l� S=�80 °"" <br /> � cllr MRMEg�IICENSF IA <br />� ', PLUMlINO � MECMANICAL <br />. NO. � �?YPE OF flIITURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(?OILET) � A/C—A/HNOLO UNiI'S—H.P. <br /> � <br /> BATHTUO � ' FORCED Alq SYSTI:MS—B.T.U. M E.A. � <br /> LAVATOFlV(WASH BASIN) �— UN�T HEATERS--B.T.U. M � <br /> SHOWER � CLOTHES DRYERS � <br /> KITCH�N SINK 6 OISP ; VFNTILATION FAN � <br /> DISHWASHEri � RANGE HOOD �— <br /> LAUNDFVTRAV ; WATER HEATEF � <br /> CLOTHES WASHER � WOODSTOVE <br /> i <br /> URINAL � METAL FIREPLAC:E 8 CHIMNEY � <br /> DRINKIN6 FOUNTAIN � FIHEP�ACE INSf:RT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; 6AS PIPINO � <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN , <br /> SINK(SEFVICE—BAR,ETC.) � � <br /> � i <br /> -- ' <br /> — . _ ' i <br /> — � � <br /> -- ---�-- _ i <br /> � --T— <br /> � <br /> SUB TOTAL S i SUB TOTAL S ' <br /> PERMIT S � ?ERMIT s i <br /> 1O711L FEE S ' TOTAL FEE S -�i� <br /> �.�_._ <br /> FOR OFFICE USE ONLY: <br /> FNONTSE78ACN pEAqSE�B�f,R 6��1 SEIpACN PL�NCNEf,kNIM10E11 FFE RECEIPfNO. <br /> ;37OLn� <br /> USEIONE LOTAREA Y�Cnr1T6iTE fEE9 VALUATION FEE <br /> BUILDINO /.�.8 � p/ iSG <br /> lYl[Of CC41g��IJLOWABLF fYPE Of 1pN51 ACIII�L ¢���r rp aqq��pqunt5 <br /> �I ^'�( ' I` � G.�. PIUMBINO i <br /> i <br /> S OF BLOA Np.Lf 6t0111Ee BA9EMEN7 MECHANICAL ' <br /> 60 S .FT. � ' _ <br /> OCCIIPANCYIOAD FIPE$PpN10.ER9RE0'D NFNiMIWIT�710N ADDITIONRLPLANCHECN ��� � 9 7 <br /> 0 �J 9 --'— <br /> RE�SON fOfl 6PPINKLERS SPRINKLER ; <br /> �_T'_" <br /> STA7E BUILDINO SURCHAROE �sv <br /> INUNE BY -' �--�—�— <br /> vu��PROVED BY CITY OF EVERETT PUBIIC WORKS ; _ <br /> Y LOCAL SRLES � <br /> /� � TAX CODE IS 310b TODL �`� � 9 <br />