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APPLICATIC��� FOR CONSTRUCT 3N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUiLuiiJG �FPARTME��T HEATING SYSTEM: � GAS �ELECTRIC ❑ <br /> 259-8810 <br /> I 1 DEMOLITION ❑ CORABINATION I 1 BUILDING ;XMECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER // MpAIL����DORE55 CI1Y ^,�/^ ZIP 'w PIIO�IiE / / <br /> tENA 7. / '^` CIi/�• U9��WV C� .L�V.C/J �/7 �J���`/ <br /> MAIL 4DpRESS CITY LP PNONE <br /> CI.Z.� S_� � BFar i c. � Z825" Cv(8«�EUE�zE/'��/�iA <br /> �RGIIIiEC'p'��.DESIGN q MAR AODR � Gi —� LIP PI/ONE <br /> �G��C..�Q1i�`Il/ .q2�L� � �rol1 z��7.�f/• ��Ll,�� <br /> GCkCRO CMlRnCTOR IdpILA00RE55 CI1Y ZIP PlIONE STATELIGENSEa <br /> 5/�oT'C)a.1�C, Ev I <br /> MECHANICALCONTRACTOF MAILAOOPE55 Cltt 21P PMpqE S7ATElILENSEO <br /> �vy�rc �l ; in fC. ��o C �� ��iud".,� x�, „ —��������Q,� <br /> PUIMBING CONiRnCiOF MqiL ADOFESS GTY 21P GHONE $T TE UCR ENS[M <br /> C C7 PpuE OF�WORK 1 <br /> %�7 W�• <br /> D�ES�C,R.yIpE�WORN—AN��'50}{A�R FOO7AGE INVO VEO /�� CONiACT PERSOY�N�PHON NO <br /> �--�_�/}� '4/M/ }��/ ��%0�/A / c1_ 4 ��� �llEL�i .S�"/l� t� <br /> I HEREBV CERTIFY THAT I HAVE REAU A�D E%AMINED THIS <br /> raoapsenuseoFou m/Nc� APPLICFTION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> —�7> ��L�'� PRCVISIONS OP LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ��cni fIESCRIP110NOFPqOPERr,�SHOWNBELOWOPATTACHTWbGOPIES) WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR <br /> �or etocK oc � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHUFiITY TO VICLATE OR CANCEL THE PqOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REr,ULA7ING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT i AM AUTHORIZED OY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR N'HICH <br /> rnnce�Tnxi.o.r+uueea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW A4D 296.200 WAC. <br /> CONSiRUCTION I.OAN LEN�ER.ADDRE55.TEIEPHONE NUMBEq �� �� p <br /> PRO�E�TADDRE$6, , /�n� / _��� <br /> �u sicr�.tuar p�r� <br /> ���� � � �� cnrnus'iwessncrr+sn�o <br /> _G�f�L—L�LLL <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET�TOILET) A/C—A HNDIG UNITS—H.R � <br /> BATH7U8 J FORCED AIR SYSTEtdS—B.LU. M E.A. <br /> Ll.VATOflY�WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS �— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> � <br /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER i WOOD STOVE <br /> URINAL ; METAL FIFiEPLACE(WOOD BURNING) —� <br /> _ DRWKING FOUNTAM FIqEPLACE INSERT � <br /> FLOOFi DRAIN � HEAT PUMP —T <br /> i � <br /> BACKFLOW PPEVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS —�-- EXHAUST FAN <br /> SINK(SERVICE—BAR,ETQ� ; --~ <br /> � � <br /> I � <br /> 1 <br /> 1 <br /> 1 �- <br /> SUB TOTAL $ ; SUB TOTAL 5 � <br /> PERMIT S � PERMIT 5 ��I <br /> TOTAI FEE 5 TOTAL FEE 5 l� <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK qEARSETBACK S�DESLI6ACH PL4IJCHEf.KNt11.1(;ER FEE REGEIPTNO. <br /> us�zor+E LOTAREA VqCANT5ITE FEES VALUATION FEE <br /> fl YES f'� NO —�— <br /> BUILOING <br /> iVPCOFCONSi, NO.OFSTOFIES OCN^nucr xoo�mvmci�uvus <br /> usaw pLUMBING � <br /> S2EOFBLOG. FlRESPRINKLERSREOD BASEMENT MECHANICAL / � <br /> ❑ YES ❑ NO � <br /> OCCUPANCYLJAO FIREALANMRE00 N[IGHTLIMITAiION A�DITIONALPLANCNECH � <br /> OTIIER i <br /> FEASON _ � <br /> STATE BUIL�ING SURCHARGE � <br /> tNTAKL BY PLANS APPRpVED�V i <br /> CITY OF EVERETT PUBLIC WOAKS � <br /> �1� LOCAL SALES <br /> onre c� ��� TAX CODE IS 3105 TOTAL <br />