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APPLICATIC^�I FOR CONSTRUCT.)N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> il11LDING DEPl1RTMENT HEATING SYSTEM: �J GAS Ll ELECTRIC I,J <br /> 259-8810 <br /> � DEMOLITION _I I COMBINATION I I BUILDING �MECHANICAL I I PLUMBING I 1 SIGN <br /> orrt�te Mai nnnness <br /> � CI7Y 21P PHON[ <br /> TENA�,-��--� �-����-�-?� �'�'�� t�lETl:.a?F� J4�.4G�""u/.A� 9BTo/ <br /> IAAIL qDDRCSS C17Y <br /> �� //_...� �LY't ZIP PIIONE � -- <br /> i�r�r S �TIo� <br /> t65 U7V ZIP <br /> ��ES �S�I���/�.r� PHONE <br /> Gfi+EfinLCONTP.qCTOq MRILADORE55 <br /> —_� ,� � .�� CIiY IIP PIIONE SiATE IICENSE t <br /> ��� <br /> IALCNANICF�CONiRACTOR AIAIL�D�RC55 CIIY <br /> y� �r Z�P PIION[ STATE LICENSE a <br /> � �� �"/� //1�//'�/� /d�ir �/1 4...2Y1� i� // <br /> PI.UMOING CONTIIACTOB AIAII ADDRC 5 CITV �n�""4�����s {�N/v�L �L:Ad <br /> �I�I� �� ���, ZIP I i,JNE 57A7E IICENSE� 1 <br /> CONTRAC7 PRIC[OF WOflK <br /> 2� cr� <br /> DESCBIOEWOPR DSOUApEF00TAGEINVOLVED <br /> GONiAC P[pSONAN[PIIONEHO <br /> �l���� 1�_T�,2 ��� �64-9f� <br /> " ����u c��� b�— i HEqEOY f,ERTIFY THAT I IIAVE READ AND EXAMiNED THIS <br /> r�aorasco use oF umion�c <br /> APPLICATION AND KNOW TNE Si�ME TO BE TRUE AND CORRECT.ALL <br /> PRCVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ieea�oescravTror�orrnorenrvisi�owr�a�ioNonnrmainvocoriesi WORK WILL BE COMPLETED WITH WHETHLR SP[CIFIED HEREIN OR <br /> ��T eiacn o�. NOT. THE GRANTING OF A PERhIiT DOES NOT PRESUME TO GIVE <br /> AUTHOqITY TO VIOLATE OR C�NCEL TH[ pROVI510N5 OF ANY <br /> — OTHER STATE:OR LOCAL LAW qEGULATING CONSTHUCTION OR THE <br /> PERfORA1ANi-E OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER Of TIiIS PROPERTY i0 PERFORM THE WORK FOR WHICIi <br /> ��nnr,e�iazio Nur.ioeq APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS L 1827 296.200 WAC. <br /> ,CONSI{iUCT10NlORNIENIIER.ADDf1E!i5.iclpPHpN NUMp[p/� -"�– <br /> PROJECT AUD �S b 7 ��1—�—" � <br /> s¢. � - na[ • <br /> cur nu.wi,s i e.�rui_r�n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF�rIXTURE Oq ITEM FEE NO. TYPE OF EOUIPMENT <br /> _ WATER CLOSET�TC�ILET) FEE <br /> ' .4�C—AiHNDLG UNITS—H.P <br /> BATliTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ~-- <br /> _ LAVATORY�WP,SH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYERS �-- <br /> KITCHEN SINK 8 DISP ' VENTILATICN FAN � <br /> DISHWASHER �— RANGE HCOD �'— <br /> LAUNDRY TFiAY � � <br /> CLOTHES'NASHER — ' WATEFiHEATER , , <br /> � WOOD STOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSEFT <br /> FLODfl DR�IIJ � I1EAT PUMP —T-- <br /> BACKFI.OW PREVENTERS ; GAS PIPING � — <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK ISFAVICE—BAR,ETC.) � — , �;__ <br /> -- � <br /> — , — <br /> — ; <br /> —— ' <� �'— <br /> — 1 - <br /> —, — <br /> --;— <br /> _ SUB TOTAL $ ' SUB TOTAL $ <br /> ----�— � <br /> PERMIT $ � PERMIT $ � ' <br /> TOTAL FEC- 8 —~ -- ' <br /> .— TvinLFcE �y � j i-- <br /> FOR OFFICE USE ONLY: — <br /> FRONIS[Tf1ACK pEaRSETBAGN SIDESETBACK PLANCNECRNUMBER <br /> PEE RECEIPiNO <br /> 4w � <br /> USE 70NE LOi AREA VACFNT SITE FEES VALUATION FEE <br /> Il vE5 Il No euauwc , <br /> irP[bcoNsi NOAFSTdilES nruruKr rronr�wxcimns – � <br /> GNp�P — <br /> rwrnoiN� � <br /> 512[OF OI.DG FlRE SPPINNLEfl517E0'0 DASEMENT ---�-- <br /> I I YES (I NO MECHANICAL � <br /> OCCUPANCY IOA� FIpE�LAP1A PEO� ��[�GIIT LIM1IATIOtJ A�DITIONAL PLAN CHECK i—� <br /> i <br /> — _ � <br /> nEnSON OTHER i <br /> S7AT[�UILDING SURCHARGE �— <br /> imnKc nr ruvsnr aoveom CITY OF EVERETT ruouc wo�Hs ' <br /> � LPCALSALES <br /> op�F �( Q TAX COOE iS 3105 Tora� <br />