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APPLICATIC"�1 FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> L _ _ ___ _ — _ _ _ _ — — --- <br /> BUILDING DEPARTMENT HEnTING SYSTEM: J Gns J ELECTRIC J ___� <br /> 259-8810 <br /> DEMOLITION COMBINATION � BUILOING MECHANICAL PLUMBING SIGN <br /> Owry�N �dn[ nl�i�nrbs ��'� rilv tin - " - <br /> � m�orn <br /> _�-�t. I?x�:,.'J�� i".l; t ' C� G (�. � 7��; /;;�� �j r+— �'�, �F�}-'l"�, �•.,r . �0�Ly, <br /> iiNnNt aai�ooness crt zm — m�oNe <br /> `.�1NS� /k: J:vN,S,C� <br /> Mh]atECiOR0E51GNFR MAiL11D�i1E55 CiIV Ii� PHONE <br /> �tJS2c-F.,.rE::.rl ��nC�r���_G�2E-71- ,•'ivCiTiF'S per"N7' <br /> �1fi1FRRlCONiR�CiOF MRIIRDOAES;i CItY 1iP PMONE STQEIICENSE� <br /> C-CiMFKi� . <br /> 6iFG��NiCQCONTP�CTOR M�II��ORESS CITY ZIP nr�ONE STATELICENSE� <br /> PLUIdBINGCONiR�CiON M�ILADORESS CIiV 21P PHONE STRiEIICENSE� <br /> CONfRRCT PRICE OP WORN <br /> � <br /> OESCRiBE WORN RND SOWfIE FOOtAGE INVIXVEO CONtRCT P[RSCN ANO PMONE NO <br /> LG.�n�4ti% �rLr^l3o� .rl 7�c.l,-3r�s <br /> -L����"�T ������'��'V/r�n�r�_ I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> caoroseo use ov emiowc APPLICATION AND KkOW THE SAME TO BE TRUE AND CORREC7.ALL <br /> �r����« � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGAlDESCRIPTIONOiPNOPERTYiSNOWN9ELOWOR�iT�CHiWOCOP1E5i WORK VJILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR � <br /> ior e�aK oF �— NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OF LOCAL LAW qEGULATING CONSTRUCTION OF THE <br /> PEFlFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNcR GF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PAqCEL TA%I�NUMBFR CONiRACTORS LAW 1B.27 i7CW AND 296.200 WAC. <br /> CONSTf1UCTION IO�N IENOER.qpOqE55.TELEPMONE NUMB[R --}-- , � <br /> , –""'-� �+��!_'a,.���� � //'�"��` — <br /> PROJECT ADDRESS ,/ . �, ����� �„rf <br /> Sf�L>j J. C�.FiS�nk", �d7 ys — c� :'-h — <br /> > ::n.nuv�ec,nnr..i i. <br /> PLUMBING MECHA4ICAL <br /> NO. TVPE OF FI%TU9E OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A C—A HNDLG UNITS—H.P � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVqTORV�WASH BASIN� UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHFS DRVERS �— <br /> KITCHEN SINK 8 DISP . VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> � LAUNDRV TRAV WATER HEAT[R <br /> CLOTHES lYASHER WOOD SiOVE <br /> URINAL METAL FiREPLACE�WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN I1EAT PUMP <br /> BACHFIOW PREVENTERS GAS PIPING <br /> ROOF DFAINS—RAINLEADEFS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) <br /> — �— <br /> _ SUB TOTAL $ SU�TOTAL $ <br /> PERMIT S PERMIT S <br /> TOTALfEE $ TOTALFEE $ �— <br />'I FOR OFFICE USE ONLY: <br />� iRONLSEiB�CN qEARSFLBACK SIpESEiB�CY PL�NC��FC NUMPfR � f(f (IECEiPTNO <br />! '� ya <br /> use zone ior nae� V�CANi SRE FEES VALUATION FEE <br />� � VES NO BUILDING ��� ; <br /> IYPk��LON57 NO OF 6i0R1E6 oro�nu;:.. r.r m ow�� ��,���, <br /> i._ <br /> i �_ � �"��� PI.UMBING <br /> SIIEOFBIDG FIRESPRINNlER5RE0'7 B�SEMENT MECHANICAL <br /> �p,�� Y! ' VES NO � - <br />' OGCl/VANCVLOAp FIRERURMqEO� NEiGNtUMITAl1pN <br /> ADDITIONAL PIAN CHECK � <br /> �j S i��5 <br /> OTMER <br /> RE�SON — -- — - <br /> E�S f�� , S7n7E BUIL�ING SURCHARGE �� <br /> i�+TeKc nv rinr�s -rnovrom CITY OF EVERETT rueuc waaKs ��� <br /> � / `�,� LOCAL SALES <br /> n�� _ a i ,� TAl(CODE IS 3105 TOTAL <br />�� <br />