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APPLfCATiC II �OR CONSTRl.gCT `)N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC � r.. .-m <br /> 259-8810 <br /> DEMOLITION COMBINATION �BUILDING MECHP.NICAL PLUMBING SIGN <br /> OWNEF MAILAppRE55 ' CIN ZIP FMONE <br /> �_o���_ � -c . e 5� �'r rh.u-� . l�.P. ?_7�, 1 �.,��4�•.ocz {h,.. ��cv� ��,�.rc�.R " I Z5�-�,:r�¢ <br /> TENANT MRILADORESS � CITV ZiP I F/0NE <br /> 'ct o�.na �-m� �` ZSl C�II�: I L CJJ..-u ' .t. �}}'.�. Zi(%"ZSi� <br /> A CNIiECTORDE5IGNER !A ADDRESS dTV ZIP PHONE <br /> � Z�1 � .�„ �ic ��i ,..... �Jc,.. '�Q�IZ yl�., <br /> GyEN�ER L CQNTR�CT� ���.55 GIN 21� PHOM1E STATE IICENSE• <br /> 1�{-�...1���w� `oyl !�•U. �ux �IS� �v%+' ZS'1 � 1�( <br /> IAEGHANICnL CONiRACTOR IdAI�A�DRE55 CITV .'P PHONE STATE LICENSE r <br /> �WNBMCCON7RACTOR MAILAU�RE55 GITY ZIP PNONE STRTEUCENSE� <br /> ClAS50'WORK <br /> . �. NEW ' : ADDITION �ALTERATION �. � REPAIR C�MOLITION WOODSTOVE/FRPL INSERT I BUILUING RELOCATION <br /> GONTACTPERSONANDPHONCNO. ! <br /> CONTqACT PRILE OF WORK �/ �>�� ���� �L�1��j 7`7� �J � ^ ��,{,'7�j4-- <br /> DESLRIBE WORH AND SOU/RE/F00�7AGE NVOWED � <br /> �fM(n.N� /�A�f�liv�T{"�� G�V <br /> PROPOSEOUSEOFBUILGING i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ���„r,i.z,^C� y l C� •��_ APPLICATION AWD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAl0E5CPIT14NOFPROPERTV�SHONT�BELOWORATfACHFOacoPies� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> L.�7��� 1 ,��L l. - A � +' � WORK WIIL BE COMPLET[D WITH WHETHER SPECIFIED HEREIN OR <br /> �o. ,o� ,�BLOGK oF r�vn� H' w� i� NOT. 711E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �V u't'� . a�- �G. �.o�t,SLw� Vt+� OTHER STATE OR LOCAL LAW REGULATING CONSOTRIUCOT ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> P a, � � Z- O,c.ur�S D OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> S� `'�` CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��v LS .�wn L L� �,t�• <br /> �� �/ � / <br /> �P [.f� � �'7C /'�i:4 w.� .J.�.,..� L Z'7 Z. <br /> PRQ1EGi A��PE55 / 1 5 niuNE D�rE <br /> ZS�I C..,r'k�h i- Ti'L?��E�� <br /> ,� �,�V� utteus�vessi�ctu�r�+o <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) fVC—ArHNDLG Uk17S—H.P. <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A..- <br /> LAVATORY(WASH BASIN) � UNIT HEATEFiS—B.T.U. M ; <br /> SHOWER � CLOTHESORYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNORY TRAV ; WATER HEATER <br /> CLOTHES WASHER PlOODSTOVE I <br /> URINAL ' METALFIREPLA 8 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE 1 RT ; <br /> --� <br /> FLOOR DRAIN HEAT PUM � <br /> BACKFLOW PR ENTERS ; GAS PI G ; <br /> ROOF DRAI —RAINLEADERS � EX 5T FAN � � <br /> SINK(S ICE—BAR,ETC.) ; ; <br /> — ; <br /> i <br /> i i <br /> i <br /> i � <br /> SUB TOTAL 5 ; SUB TOTAL $ ' <br /> PERIAIT S � PFRMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: ���. Uv <br /> Ffi0NT5ETtlACK RE�RSE7BACK SIDESET�ACN �NECNNUMBER FEE AECEIPTNO <br /> �s j� t�l _ b - 350 9 0 7v om �o, 9 v <br /> USEZONE OTAREA VAGANTSITE FEES VALUATION FEE <br /> -'� N BUP_�ING � � � ��(� ' (Tj/ <br /> TYPE OF GONiS ALL0IYABLE iv°f OF CONSi.ACTUAI atuFwtv ry0 Cr D'nnuu6 NuiS - � <br /> 'TT� lWi` , (� �7� � PLUMBING � <br /> _Y. 111 <br /> SIZEOFBLDG. NG.OFSiORIES �ASEMENT MECHANICAL <br /> 107 �i.F T.I. AlU Gi-tAfUE�: A10 Gl39/ijy� � <br /> OLCUPANCVLOAD FIHESPlRJNNLERSREO'D HEIGNTLIIAITATION ADDITIONALPLANCHECK � iZ'D <br /> IC� `�� �.�7 SPRINKLER ' <br /> FEASON FON$PRINKLERS � <br /> � STATE BUILDING SLiRCHARGE �5D <br /> IryiAKE 6Y PLANSAPPROVED�V CITY OF EVERETT PUBLIC WORK$ T� ' <br /> LOCAL SALES � <br /> 1 �M TAX COUE IS 3105 TOTAL aJ�� [�j <br />