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APPLICATIC`�; FOR CONSTRUCT'� ll� PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑EIECTRIC J � <br /> 259-8810 <br /> i DE6AOL7TIQN ! 1 COMBINATION I BUILDING �MECHANICAI f PLUMBING SIGN <br /> OWNEA ��"P /+OD�E55 C11V Zlv PHONE <br /> ✓o.vn/�IAdOE7✓ o�a70:1 L��.rsy._Qt2--_���¢t-rr' 98ao/ �SA -93s-� <br /> 'NANT M/IL0.DORE55 GTY ZiF PHONE <br /> FRCHITELt OR DESIGNER MAiL ApDFE55 CRV ` c. PNONE <br /> G[NFHAL CONTfiACTOF MAIL ADOR[55 CITV ZIP �NONE St�TE LICENSE! <br /> MEGNANIGNCONTqACTOR MAILADDRESS CIiV IIP PI:'BJL SUTEIIL[NSE• <br /> r �� �c-„�-��y i9�a�-6yT,�FJw-zJ �(r�✓�✓wnad 98�.36 �7�/'a a ii 1vo;�c�so�lP�r <br /> VWM8:4,CONTRACTOR MAILRDDR[55 C�TY Zi� PHONE SiPtELIGENSE• <br /> COHiHAGT PRIGE OF WORK . <br /> ��5% . o a _ <br /> DESCRIBE WOR�'.AN�SOU/•RE FOOtAGE INVOIVE� CONTACT PER80N AND PHONE NO. <br /> `n <br /> G�7S FURNHG'.F�Y N�✓T o[?� �yivEK/�N_�- 7 7�/—d�.Y/i <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaoroseo use oF euaort+� APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIUNS OF LAWS AND ORDINANCES GOVERNING THIS NPE Of <br /> IEGALDESCRIFTIONOFPROPERTY�SMOWNBEIOWORATTAGNiWOCOPIE51 WGRY. WiLL BE CGMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRAWTING OF A PERMIT DOES NOT PRESUME 10 GIVE <br /> wt e�ocK oF AUT�HORITV TO VIOLATE OR CANCEL TNE PROVISIOIVS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTPUC710N CR THE <br />' PERFORMANCE OF CONSTRUCTION. THAT I AM AUTH0912ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORId THE WORK FOR WHICN <br /> APPLICATION 13 MADE AND I COMPLY WITH TI1E STATE <br /> Pnace�iax�o.r+uMaEq CONTHACTORS LAW 7827 RCW AND 296.200 WAC. <br /> 3 i - o - a iv <br /> CONSTflUCTIONLOANLENDER.ADDFE55.TElEPHONENIIMBER � <br /> /0-� 7 -9y1 <br /> PROJECT ADDRESS s'01"`0'P Q�? 7is/ °"�� _ <br /> �' Q�^ f.ilYBV5Mtfi51�GEM.FNO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br />�. WATER CLOSET(TOIIEn A'C—A'HNDLG UNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� LAVATORY;WASHBASM) UNITHEATERS—B,T.U. M I <br /> SHOWER CLOTHES DRVERS _ <br /> KITCHEN SINK R UISP VENTILATION FAN ; _ <br /> DISHWASHER RANGE F'OOD � <br /> LAUNDRVTRAY ' WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE �_ <br /> URINAL ' METAL FIREPLAGE�WOOD BURNING) � <br /> DFINKING FOUNTAW FIREPLACE INSERT I <br /> FLOOf7 DRAIN � HEAT PUMP _ <br /> BACKFLOW PREVENTEflS GAS PIPING _ <br /> ROOF DRAINS—RAIN�EADERS EXHAUST FAN <br /> SINK tSERVICE—BAR.ETC.) _ � <br /> �� vr�o � <br /> � ..vv �,... � <br /> �- <br /> SUB TOTAL 5 ' SUB TOTAL $ ^�,7 ' <br /> PERMIT $ PERMIT $ �� � <br /> TOTAIFEE 5 TOTALFEE 5 (� <br /> FOR OFFICE USE ONLY: _ <br /> FRONi SETBAGK fiEAN SEtAACK SIDE SETHACN PLAN CMEGN NUMBEfl FEE RECEIPT NO <br /> 1r��3� <br /> U£E20NE LOTAR[A VACANTSiTE FEES VALUATION FEE <br /> ,^.:' YES ❑ NO BUIL�ING <br /> TYPEJiCUNSi. NOAFETORIES O(CWWtv NOqUwfwrvtuN��S — <br /> cuoov p�UM81NG <br /> SRE OP BLDG FIRE SPRINNLERS REO'D BASEMENi MECHANICAL � <br /> � YES '_7 NO � <br /> OCCUPANf.Y LOAD PIRE ALARM PEO'D HEIGNT LIMITqiION A�DITIONAL PLAN GHECK i <br /> i <br /> OTHER i <br /> —� <br /> � PVASON _ <br /> S1ATE BUILDING SUPCHARGE <br /> INTAKEBV PLANSAPPROVE09Y CITY OF EVERETT PUBLtC WORNS <br /> LOCALSALES <br /> oa.e TAX CO�E IS 3105 rora� <br />