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APPLICATIO�� FOR CONSTRUCT� JN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> ��.. „ <br /> BUILDING DEPARTMENT HEATING SYSTEM: I,J GAS U ELECTRIC U___—� <br /> 259•8810 <br /> DEMOLITION COMBINATION BUILDING X MECHANICAL PLUMBING SIGN <br /> OWNER MAIIADDqf55 ptV 21P PHONE <br /> AoEiivt. � . .goo3 W G ��lo �D. F✓fRE iT 98'�0 3 <br /> TEN�NT MM��pDRESS piV ;IP PHONE <br /> M E <br /> ARCHITECTORDESIGNER M�II�ODRE55 d7Y iIP PHONE <br /> GENF.F�I CONTR��TOR M�II�ODHE55 LITY ZIP PNONC STATF LICENSE� <br /> WR1aNs �a���es N�eeoR .�03 W �n' SrNo /ZD E✓et� 98��3 342-2756 <br /> MECMANICAI CONTR�CTOR AIAL�ODRE55 CITV 21P PHONE STA:E IICENSE/ <br /> �N_BERSON MAGRUDC-R Q�tL��YUweoD A✓� N. Sl`QTIC[- 9�/03 7�'�00 ,(�yDL�PM� 9� // <br />' PWMBINGCONTRAGTOR MAII�OpHE55 CITV 21P PHON[ SiQEIICENSEt <br /> SAM E <br /> GL�ES OF WORN <br /> �(NEW x AODITION ALTERATIGN REPAIR DEMOLITION WOOD�TOVEiFRPL INSERT BUIIDING RELOCATION <br /> corvucrrEP50�N�PNOti'No/Ay/oR 784 '�� <br /> CONiR�LTPRICEOFWORIt 6��0�� A �� <br /> DESCRIBE WOR1c RND SOVARE FOOTAGE INVOLVED <br /> .�00 GA[. (JS T fOR WASTE F/RE WA1F <br />� PPOPOSEDUSEOFBUIl01N6 i HEREBY CERTIFV THAT I HAVE READ AND EXAMWED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> IEdALDESCRIPTqNOFPpOPERiv�SNOWNPEIOWOR�it�CHFWRCOPIESI PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHEH SPECIfIED HEREIN OR <br /> �ot _ eiocK or NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IMC TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PeRPOPMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED AV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />' APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CUNTRACTORS LAW 18.27 RCW 0b 2g6200 WAC. <br />' i- <br /> PROJECT ADDRE55 x �� �� �J � �9� <br /> Su'AU,�Uqf U�IC <br /> 3 S/QO � F3L � � u�rxas�.sssnrner�vo -- <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� A,C—A�HNOLG UNITS—H.P. <br /> BATHTUt3 ' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATOHY�WASHBASIN) �— UNITHEATEHS—B.T.U. M <br /> SHOWE9 CL07HESORVERS —T— <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAV WATER HEATER <br /> CLOTHES WASHER WOCD S70VE <br /> URINAL METAL FIFEPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DPAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF ORAINS—RAINLEADEHS EXHAUST fAN � <br /> SINN(SERVICE—BAR,ETC.) � <br /> � <br /> — / Us T - w�+r�R - <br /> � <br /> SUB TOTAL S ' SUB TOTAL $ <br /> > <br /> _ PERMIT S PERMIT S <br /> TOTAL FEE $ _�(j' � TOTAI FEE $ — <br /> FOR OFFICE USE ONLY: <br /> iRONT5EIBACK PERRSETB�CN SIDESETB�CN PL�NCHECNNUMOEF FF.E RECEICiNO <br /> useior�e iorene� V�C�NTSRE FEES VALUATION FEE <br /> BUII�ING <br /> iYPfOiGONISULOWABIE TVPEO�CON5IAGIWI a'cuwvcr xonowf�.�i��mrs — <br /> �p�� PLUTABING !I <br /> — 2V � <br /> � � <br /> SRE OF BLOG NO OF STORIES BASEMENT MECNANICAL � � <br /> � <br /> OLCUPANCVLO�O PIRESPPNNlERSPEOD HEIaHilIM1UT10N ADDITIONALPLANCHECN <br /> SPRINK4^Fl <br /> REASON FOR SPPINNlERS _ <br /> _�— <br /> S7ATE BUILDING SURCHARGE <br /> INT�KE BY P�ANSAPPROVEp BY CITY OF EVERETT PUBLIC WOiiKS <br /> LOCAL SALES ' <br /> TAX CODE IS�105 TOTAL 2� � r <br />