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APPLICATIO' ° FOR CONSTRUCTI N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ---- ----- -- ----- ---- - ----- ----- <br /> BUILDWG DEPARTMENT HEA7ING SYS7Enr. J Gns J ELECTRIC � ___ __ __ _ I <br /> 259•8810 <br /> —1 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> OWtlEA IAAI��UDRE55 <br /> ��T� IIP PwONE <br /> ,(3o�in,S e.o. Q, a. ,da�c 37 u� S o/f-i? SS��rLd ,/ ^� <br /> tE'14hi IRiI R��RE55 __ _�'_�_- / Zio �—fwA • 4���y �J Z..�/3�9 <br /> CI'Y � t'HONE <br /> ��/N6 . - <br /> ��ACNiiECTOPCES•GNCR NAi��ppqE55 UiV ZIP P��ONE - <br /> (jDEid6. <br /> GENEPs��ONTR��iCF r,qI�ADORE55 LI*V 21v PNONE <br /> �V�n �.��� 1 SiA1ELiG[NSE• <br /> •..�a iv /�4L�/(i <br /> �,�KNq'uCAI CONiqA�TOR R4i��pDRE55 CitY 2iP PHpNE -�- <br /> SiAiE UCENSE• <br /> PLU�d81NGCONiR��TOR IAAI�,�DGRE55 GfY - <br /> z�P PMpNE SiniE uGENSE r <br /> CONTR�CTPRiCE0FW0�[ / ^ / � - ___ <br /> CY <br /> 0[SCFiBEWOFN1ND50U�REF ta�E,NVOlVEO GONi��iPER50NRNDPHONE'�J <br /> I2-(S'LOGl�-TE' �'�t.arL�r� �j L�.I��.vr,� [,cso�v�tip �sTE�.l?oaski 26s --3sG� <br /> OOIZ—��L�M�VE IMTElyO`- G�/gLl /;iaD 6�/�� � HEREBV CERTIFV THAT I HAVE READ FND EXAMINEU THIS <br /> Paoaoseo usc or ow�oiva APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � k <br /> PHOVISIONS OF LAWS AND URDINANCES GOVEFNING THIS TVPE OF <br /> IEG�LDESCRIOT�ONO�PROPEHiv�SNOWNBELOwORATT�CNTWpLUP�•,--� ydORN WILL Bt CGMPLETED WITH WHETHEq SPECIFIED HEREIN OR <br /> ior e�a„ oF _ _ _ NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> AUTHOHITV TO VIOLATE OR CANCEL TFE PRObISIONS OF ANV <br /> __ OTHER STATE OR IOCAL LAW REGULATIN�i CQ�JSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION. THAI� I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TC PERFOPM THE WORK FOR WHICH <br /> aeRCE�T�. � NNABER APPUCATION IS MADE AND I COFdPLY WITH THE STATE <br /> CONTRACTORS LAW iB27 RC'V �yD 296200 WAC <br /> CONS�RUCtiOr��OANLENDER �DOAESS.�EIEPHONENUiABER ) � �..--�t / <br /> PROJECTADDpESS �tr�-�Y== "" �" � � .�J '_.,��/. <br /> 3� /'. s�c�u•�i,�� �- �-nui -_... <br /> 03 w G�•Qr/Np ��� r�.$�O% u�rnusnt5s.��rr.srT�.� __ <br /> PLUMBING MECHANICAL � <br /> N0. 7YPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPA7ENT FEE <br /> WATER CLOSET(TOILET) ArC—AMNDLG UN'.TS—H.P. <br /> BATHTUO FORCED AIR SVS7EMS—B.T.U. M E.A. <br /> LAVA70Rv�WASH BAS'N� UNIT HEATEFS—OS.U. M <br /> SHOWER CLOTHESDRVERS <br /> HITCHEN S14K 8 DISP VENTILATION FAN <br /> _ DISHWASHER RANGEHOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CLOTHES WAS.IER WOOD STOVE -- <br /> URINAI METAL FIFEPLACE (WOOD BURNING, <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUMP �— <br /> BACKFLOW PREVENTERS GAS PIPING — <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR.ETC.) — -- <br /> SUB TOTAL S SUB TOTAL E <br /> PERMIT � PERMIT $ <br /> TOTAL FEE f TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> F10NItiEipACK PC�NSftI1nCK �-__-�— $iDE5ET04CK----- PIANC��-,NNIIMpF.f1 f([ B[CEI�'INO <br /> �_ r �7 <br /> uSezcNe ior�nee VALANTSRE FEES VALUATION FEE <br /> ��� VES -�� NO [{uRDINc <br /> tvV[��GOHSf NO OF STORiEb �rri���.,�, r�a a��w¢vxcvm�s <br /> r,oa:n - -- <br /> L PLUMBING <br /> SiZ[OFBLDG FiqESPFiNNLEA5RE0-D B�SERIEN* -'— <br /> MECHANICAL ' <br /> ^ 1'ES .-, NO �_ <br /> OCCUPANCV�OAp viqEeuaMRE00 MEiGHiuMrtetipry ADDITIONALPLANCHECK <br /> nEn50n OTHER <br /> ---T__" <br /> STRTE BUILDING SURCHARGE <br /> �NTArE fiv �i�NS AocqOVED B� CIiY 0F EVERETT PUBUC WORKS <br /> LOCALSALES <br /> o.re TAK COOE IS 3105 rora� <br />