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' ' _ " � " ' � � • • v�� •�V�1i��� �- ��� � — — .i <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br /> .- '�n <br /> BUILDING DEPP.RTI�IENT HEA7�NG SVSTEM: ' GAS �]=LEC7R�C �► <br /> 258-8810 - <br /> ❑ DEMOUTION ❑ COMBINATION O BUILOING �AECHANICAL O PLUMBING r] SIGN <br /> � C��'aon¢es ' cm nn'� r�a+e — <br /> C <br /> h�.� �Yl �\� �C� � �C�cm �ir n� <br /> y'� �y '� r�(1���' ��P����- � 1Rac i <br /> 1 1 I 1 \ M�L,100RESi . 1 C�T. ZiP P�DNE . <br /> J <br /> I ��I-1 wa�oonew cm z�a nHoroe fiATfiUCENBE/ <br /> Me�.l�a,�ron uµ�ooR¢u nrv <br /> iW °MpNE � 'u B7A�ENBE► <br /> ��q�T�T� �1MOHES4 GTr Z�V v�qNE iTATEUCEHiE� <br /> ��'�(1 <br /> DE�p1�L MO�M(N1D/0{IME fppTAOE MyplyEO CONT�CT VEREpI AND iHON(Np <br /> " � \I � � � JI <br /> � <br /> r p�aw�p�p � HEREBV CERTiPV THAT I HAVE REI.D ANC� EXAMINED THIS <br /> �� , "� ,� ' APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �E�����T��P�EpTr��'�'NBE��WONATTACN7WOCOPIE61 WORK WiLL BE COMp�ETED WITH WHETHER SPECiFlED HEREIN OR <br /> �oi µ� � NOT. THE GfiP.NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS Of ANV <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION Oq TME <br /> PERFORMANCE OF CONSTRUCT104. THAT 1 AM AUTHORIZEO BY THE <br /> OWNER OF TNIS PROPER7Y TO PERFORM THE WORK FOR WHiCH <br /> ►�nCEIT(oc1.D.NUWe� APPUCATION IS MADE AND I C[1MPLY WITM TME 9TATE <br /> CONTRACTORS lAW 1827 RCW AND 298200 WAC. <br /> CpNT11UCTI0N LQW LENOER.hDOREBB.TEIEPMONE NWBEH �> <br /> PROJECTADDN S � �� �.� �-+ � � ��1i A b1� �C������1� <br /> r I 1 S U t D�i[ � I <br /> Y ) a , .�a.v� <br /> PWMBING MECMANICAI <br /> NO. TYPE OF FIXTURE ON REM FEE f�0. TVPE JF EOUIPMENT FEE <br /> WATEH ClOSET(TOIIET) A,�C—A�H�uDLG UNiTS—NP. <br /> BATMTUB FGAGED AIR SvSTE�dS—B.TU. M EA <br /> I.AVATORV WASN BASIN) UNIT HEATERS—B TV M <br /> SMOWER '� GLOTHES DRVERS <br /> NITCHEN SINK 6 DISP ' VE�JTII,ATiOF:FAN r <br /> DISHWASHER RaNGE HOOD <br /> LAUNDRYTRAV WATER NEATER <br /> CLOTHES WASHER WOODSTOVE — <br /> URINAL METAL RREPIACE (WOOD BURNING) <br /> DRINKING FOUNTAIN FlREPLACE iraSERT <br /> P100R DRAIN MEAT PU�AP — <br /> BACKFLOW PREVENTERS GAS PiPiNG — <br /> ROOF DFAINS—RAINLEADEFS �— EAHAU57 FAN — <br /> SINK SERVICE—BAR,ET0.) <br /> � , <br /> � <br /> r--- <br /> __ SUB TOTAL f SUB TOTAI b iD ' <br /> PERMIT E PERMIT y <br /> TOTAL FEE f ' T07�;Fcc 5 ., � — <br /> FOR OFFICE USE ONLY: <br /> FAONTtklMCN REAR$ETEA�N fiIDESETWCK VIANCHECKAUMBEp� iEE RECEIFTNp <br /> � OO <br /> usEiorrE LO7ARE� V�C�NTB�TE FEES VALUATION FEE <br /> � VES - NO <br /> M[qCONit NO.WiTOniEi occu..rcr woapn«�rcuyns BUiIDiNG � <br /> ��� PLUMBING � <br /> i <br /> B��K�� FIRE6VPMH0.ERBRE09 6ASE4ENT <br /> O YES O NO MECNANIC1l � <br /> OCCUPN/CYLWD fIRENARMREO'D MEqNTUMiTe7pN �DOITIONRLP�ANCHECN <br /> i <br /> AF�BOH OTNER . i <br /> � <br /> STATE 8U401NO SURCHnRGE ' � <br /> �MT��� FIANBAVPRpyFO W CITY OF EVERETT PUBUC WORKS � <br /> LOC11L SAIES <br /> o�re TAX COUE IS 3105 TOT�i �— <br />