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APPLICATI( � FOR CONSTRUC7 . JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS :J ELEC7AIC U � <br /> 259-8810 � <br /> i � DEMOLITION i I COMBINATION i i BUILDING i_; MECHANICAL �LUMBING [ � SIGN <br /> OlSNER M�ILAj1DR���� ���'��� pHOf1� /��/ <br /> �R7�� �� <br /> �`,�TT. ;G• 7 , �c,Pa i <br /> �TE1 i MAIL 4D�RE55 CITY ZiP PHONE <br /> sc� �Il�vu� <br /> /�iGniECTOqDE'iGNER MAILADORESS QTY 21P PHONE <br /> GB+ERFI WNiiiACtOR MRILADDRE55 CITY 21P PHONE SiATELICENSE• <br /> ��-�. F„� Po �K �.v � , t�F��-;T 9£��.�'����/��� <br /> MECHANIGALCONiPAGTOR MNLApDRE$5 CIiY 2�P PNONE STATELICENSEI <br /> PWMBiNGCO RACTOR M�ILADDRE55 Cltt D? PIIONE STAiELICENSEY <br /> -s �46G /,�/ io,� ,4v.�,1� � ,� N��s �o X�-�a�� A,e�A/-i�3�� <br /> �GONTRACT�PtCE OF�K <br /> C5[1� <br /> DESCRIBE WORN PNO SOUARE FOOTAGE INVOLVED CONiACT PCRSON AND P40NE NO. <br /> i HEREBY CERTIFY THAT I hIAVE READ AND EXAMINED THIS <br /> rnoros�o use oF nuTaoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> c PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGFLOESCRIPTIONOFPqOPERTY�SHOYMBEIOWOflAiTACHNJOCOPI[5� WORK WILL BE COMPLE7ED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT oiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESLIME TO GIVE <br /> /J ����t// AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> o�I��� ('D,(R OTHER STATE OR LOCAL I.l�W REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARGELTA%ID.NUM9CN <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTqUGTIONLOANL[ND[R.�ODRESS.TELEPHONENUM�ER <br /> PROJECTADDRESS Xv.,�n� —��,,�� - <br /> J / CIiYWIS��IfS5Ll.1'u�.l M] <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) !VC—A;HNDLG UNITS—H.P. <br /> BATHTUB FORCBD AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYEFS �— <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISNWASHER FANGE HOOD � <br /> LAUNDRYTRAV ' WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN HFAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINL[ADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � <br /> IS , Ce � <br /> `'� e ' � <br /> � � <br /> SUB TOTAL $ SUB TOTAL 5 � <br /> PERMIT $ � PERMIT $ ; <br /> TOTALFEE 5 TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBFCH REARS[Tp�CK SIOESCiBACN (IANCN[GNNUMOER PEE RECEIPTNO. <br /> USEZONE LOTAREA VRCANi51TE FEES VAIUATION FEE <br /> Il YES ❑ NO BUILDING <br /> fVfE9FCON51. NOAFSTOAIES occurAxn hnorm�iwx4uxn5 <br /> cxou� PLUM�ING � <br /> SIZEO�NLOG. FIRESPPINKlER5RE00 BASEMENT IdECHANICAL � <br /> f7 YES Si NO � <br /> OCCUPANCY LOAO FIRE�L�RM PWD HEIGMT UMITAiION ADDITIONAL PLAN CHECK � <br /> � <br /> OTHER i <br /> RCASON <br /> — —T <br /> STATC BUILD�NG SURCHARGE � <br /> w�nHi�v riaNsnrvaoveo ev CIiY OF EVERETT pueuc wot�Ks <br /> LOCAL SALES <br /> onTe TAX CODE IS 3105 TOTA� ; <br />