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APPLICATIOf"`FOR CONSTRUCTI�N PERMIT �✓� <br /> �� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ,y <br /> 1� _ _ _ --- ----- <br /> --- � <br /> ' HEATINGSYSTEM�. JGAS JELECTRIC J ___ ____. <br /> BUIL�iNGDEPARTMEI�T L__.____ ________________ � <br /> 259-8810 - - --- <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> owr�En Mainonn[ss ..--___ _ .______._____— __________.___.__.___ <br /> crt, :u� m�..�at —_. . __. — <br /> T�E BoEln/ Go. P. o. BoX 3'70'1 , M�s oF-'7�� S6'9TL� /�A. 9$l2�/ 26`-?sG 3 <br /> iEN�NT qAI�ADDRf55 —1----- <br /> Ciiv Lr vr�oNF <br /> SA-MC' A'� OG+N67L <br /> �HCHirecronocsi:r�Ea r�nn.nnnness � r:i;v-- l�r -��-----�-�— i <br /> rHo��[ <br /> f�ova-y �r��Nc�tis i <br /> GENERMJONTR�CLOR AiML�00HF55_-- CITY 2iP PHONF Si�iEUCENSEI I <br /> �LGTGIf�5R 1^��STR�AI- ! <br /> A�ECH�NiGLCONiRACTUR MAi��UURF55 CITY bP P��ONE SLr1TELICENSEI '� <br /> �!UMBINGGONTRACIOq Mpi��D�flE55 Ulv IM1' PNOHE SIPfEIICENSE• I <br /> fONTRI CT PRIGE y W0f1N - I <br /> ��� Z$�000 <br /> OESCRIBE WORN�Np SOURRE F(bTRGE INVOIVED LON1Af.1 PEPSON A'�p PIIONF.NO <br /> _'�26-�N61NGLrt E1� _ 84�� _ (.EoNA_.2D AST�MaoRS�c I ZGL—?S�3 <br /> — ---- I HEREBV CERTIFV THAT I HAVE READ APID EXAMINED THIS <br /> vaoPoseo use cr awion+c APPLICA710N AND KNOW THE SAME f0 BE TRUE AND CORRECT.All <br /> _�mL �� 5�6�'�'� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGAlDESCRiPTqNJFPqOP[FTV�SHOWNBELOWORRRACN�WOCOPIES� WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior y�a;� . _ ��r NOT. TFIE GRANT�NG OF A PERMIT DOES N0T PRESUMF TO GIVE <br /> - — AUTHORITV TO ViOI ATE OR CANCEL THE PROVISIONS OF ANY <br /> _ ____ _____ OTH[R STATE OR LOCAL LAW REGULATMG CONSTRUCTION OR THE <br /> -- -�--�"�- P[RFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BV THE <br /> OWNER OF THIS PiiOPERTV TO PERFORM THE WORK FOR WHICH <br /> --"-------�� '--�-------- APP�ICA�fION iS MADE AND I COMPLV WITH THE STATE <br /> ��ACEl1�Rip NUMPLR <br /> COf,fFACTORS LAW 18.27 RCW AND 296200 WAC <br /> _— —__.__.___._—.— ___ <br /> coNsiuucr�ioAn�.er+otnnnnn�ssin.rn��oH¢�,uunrn ` � _ . � /� <br /> / /`-- / y <br /> -- --.. .__._.--------------- • `'1'LGwt'i. ' /r r ) <br />' PROJECTADDRESS .,,,,. ,., --- ����� <br /> 3007 W. G�si.,io /L,�. �/s-3o1 --- _ ----- <br /> PLUMBING MECMANICAL� <br /> N0. TVPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSF i (TOIL[7� A G�A HNDI.,JNITS--HP. ; <br /> ._ _— _ _'.__— __- .__. . ._ _ . _ ... . <br /> BATHTU� _..___ - _.—__—__.___ ...— __. �— <br /> ___ _ _ <br /> , FORC[D AiFi Sv,;iEMS -R.T.0 TA � A � <br /> . ___ _._ . __ ._ _.— __—.._ . . ___--___..____ .— <br /> LAVATORY 1WASH BASINI � UNIT HEATERS—F3 i U M ' <br /> _._. .—_ _ ._—__-.____..--__. , <br /> ' _ __. .. _.._ ......._ —'__._ __.__'---"__— <br /> SHOWER � CLOTHES DRVERS <br /> __ _i_ —.___ _ <br /> KITCHEN SINK 8 OISP _ VENTILATION FAN <br />' __ DISHWASNER _ RqNGE HOOD � <br /> LAUNDRV TRAY WATEF HEATER <br /> _ CLOTHES WASHER WOOD STOVE 1 <br /> __ URINAL _ _ _ _ __ ___ METAL FIREpLACE (WOOD BURNINGI �— <br /> DRINKING FOUNTAIN _ FIREPLACE INSERT �J— <br /> _ FLOOR�RAW .. .---- -�----- • --� -HFA1 PUMP -�---- — , <br /> —___--__.___._.__._______._.. __—______�.__ �— <br /> . _. __._____ —_...._ "_._ <br /> CKFLOW PIIEVfNTERS GAS PIPING <br /> _ ROOFDRAINS—RAWLEADERS EXHAUSTFAN � <br /> _ SINK�SERVICE—BAFl,ET0.1 ' -- — — <br /> __ _'_� --_____ — '_".�'_' <br /> ._'_"'_ _'_—'_"_'_'-- � <br /> __.. ___ '____—_, <br /> ___ --__' __ _ _ _--__"--- . � <br /> T <br /> SUB TOTAL 5 SU�TOTAL 5 <br /> __.__._ . ._ __._ _.. _—__ . _ .._ . . _; . ; <br /> PERMIT 5 , _ _ _ ... —___—___ ._- _ .._—__ <br /> —__ _ ______. _ ..._.____ _—____ . .. . .. .. <br /> PERMIT $ ; <br /> _ .. . _ .. __- . _.__—___—.___._._._—.._ _T__ <br /> TOTAL FEIE $ TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FqpNLSE�B�fr I1rnPSFiB4L. SIpESFiPA[� � P�nNGMf<NNUMO[n fEf PC.GCIPiNO <br /> - _- ��1 L'� ��L� <br /> u5F z'�ruF ir'nA�+ wcnai snr �- FCES VALUATION FEE <br /> VES NO � <br /> BWLDMi� p � <br /> fYl'EOfWNSt� N60FSi0R1E5 xnir�rn r'���;w1u-o„��v�. _"__ .'___._.._.__ - _ __ —._ _.I._I� �OJ _ � .�____ <br /> � ^ _'— '� N�_._ �� <br /> �.'� PlUME11NG <br /> SIZEOfPLOG RqFSPniNNEFSRfOD P�SEMENt MECHANICAI � <br /> LJ 5 .i.�r �� - VES �NO ------ -------- ------- ---'/ —. <br /> OCCUp�NCVLO�D FIPE�L�qMREOD NEIGNi�iMiLATION ADDITIONAIPLANCHECN /35� ;.��J' <br /> NJ — — <br /> nE�son ------ — OiHER <br /> _ _— �_ <br /> STATE�UIIDING SURCHARGE ��h L) <br />� �rot�He er --- nirNs e noven�n �� CITY OF EVERETT pUGL C WOFKS <br />, /� LOCAL SALES T <br /> `�`F � I - I s- 5 3 TAR COOE IS 3105 TOTA� � ���� <br />� <br />