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APPLICATIO'�� FOR CONSTRUCTf^'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT C HEATING SYST[M: J GAS J ELECTRIC , _ _ __ J <br /> 259•8810 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> 0\'lllER AUILADDRES$ CILY 21P PNONE <br /> ,�EiNs e,o. p o. �o� 3 ? o� , i'^�S off--i? Ss9�rGE w� • 4�°�Ly 3'/z--�379 <br /> TEN�NT ��iL�ODRF.55 C�T� ZiP P��ONE <br /> /jo��`�N6 • <br /> ARCurtECi0ACE51GNER A1n1�4DDRE55 CIiY .'iP GNONE <br /> �OE!�✓G <br /> GENERPLCON1eA.TOR M RADORESS Gi1V (iP PNONE SLATEUCENSE/ <br /> �,,��z�n��sa ,�as,� <br /> MECM�NIULCONiRRG10A AlqqApDAE55 CILY IIP PNONE STRTEUCENSE� <br /> PIU�AB�NGCONrRACTOR MAL�DDHESS Crtv ZiP P✓ONE St�TEUCENSE� <br /> GONtR�CT PRi�E O�NOAK � , n �� — <br /> 6 <br /> ]ESCA�BE WOAK ANO SOWAE iJOUGE iNVOWE� CONi�Gt PE�SON ANO PHONE NO <br /> Qcl.�ci!-r� 'T/L�r`s-2 � L������ [�dN�ti,� /1siE^.�.Bo�s,�� 266 .-�rL.� <br /> 002 coNsr2v�r k.�1o��/i�r6 �,�.t-r.� <br /> _(.._ _ I H[RF.DV CERTIf-V THAT I HAVI= RE.�D AND EXAMINED THIS <br /> imo��osm usr ar nu,omc APpLICAT10N AND KNOW THE SAME TO BE 7RUE ANO CORFECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �eanioescamr,or+ecrnorenrr s�awr�oe�owon�'ucNrwocon�es� WORK WILL BE COMPLE7ED WITH WHETHER SPEGFIED HE-i7EIN OR <br /> NOT. THE GRANTING Of � PERMIT CJES NOT PRESUME TO GIVE <br /> �o* B�aK o° AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSiRUCiION OR THE <br /> -- - PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHOfl12E0 B�THE <br /> OWNER OF THIS PROPERTV TO PERFOFiM THE WORH FOR WHICH <br /> APPLICATION IS MAD[ AND I COMPLV WITH THE STATE <br /> veAce�*n.i o NUMeen CONTRACTORS LAW 18.27 RCW AND 296.200 WAC <br /> GONSTFULTi09l0ANlENDER �ODRE55.tELEPNONENUM9ER `��• �/I / <br /> PRO,!ECT ADD ES9 srr,.'u�rz o.�t g� <br /> 3•�o W G.es,..,o �CD. 5�.�— '17/ �,,.a�s�Fss„�F..s,,:,: — <br /> PLUMBINO MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HtiDLG UNITS—H.P. <br /> BATNTUB FORCEDAIRSVSTEMS—B.T.U. !A E.A. <br /> LAVATORV(WASH B.4SIN) UNIT HEA'ERS—B,?.U. M <br /> .iHOWER CLOTHES DRVERS <br /> KITCHEN SINK 8 DI£P VENTILAT�ON FAN <br /> T— <br /> DISHWASHER RANGE HDOD <br /> LAUNURYTRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> Uf71NAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> �- <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS 3AS PIPING <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN T <br /> SINN iSEFVICE—BAF,ETC.) <br /> SUB TOTAL S SUB TOTAL E 1_ <br /> PERMIT 5 PERMIT $ <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETB�CR REAR SETBACN SIOE SETBACN PIpH CHECK UMBER FEE ACLEiPT NO <br /> ����� � <br /> use zoNe � ior aaea VA�ANT SITE FEES VALUATION FEE <br /> ,— <br /> :-� VES "-� NO BUILDING <br /> ivGFOt�OMSi NOOFSioRiES ncaa�,cr �nn�rw[u�n6wi�s --� <br /> °°�j0 PLUMBING <br /> Si2E0F8LDG �iFEEPn'NKLERSREO� B�SEMENT MECNANICAL <br /> -' VES -.: NO - <br /> OCCUVANCVLOAO FlRE�LARr.IREOD NEIGHTtIMIi�iION ADDITIONALPLANCMECK <br /> _ OTHER <br /> NE�SON — --r <br /> STATE BUII DING SURCNARGE <br /> INT�NE OY ����:s a��novEo o� CITY OF EVERETT aueuc wonKs <br /> LOCAL5ALE5 <br /> o„e TAX CODE15 3105 TOTAL <br />