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TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />m Z2 <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />QWWL . 1 , r- MAIL/I001101E1/ . <br />HEATING SYSTEM: N GAS J ELECTRIC Lj <br />❑ BUILDING <br />ZIP <br />❑ PLUMBING ❑ SIGN <br />- <br />CONTRACT FAKE OF W011t / V <br />\I. .CIA" W-259 <br />SOUMIE TAa EIVGWED 7 <br />CONTACT PE q <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA IRS LAW I8.27 ROW AND 2M.200 WAC. <br />' / <br />.,�z1 7 <br />P110F05[G <br />LEGAL ouawrIONa RTYISHOWNBELOW ORATTACH TWO CO►IESI <br />LOT Kock OF <br />O <br />►ANSL Tp I.O. NUMPI <br />M FNp1E NtMER <br />�� e Z 8' Lz <br />PROACT AOOR[M <br />• <br />,.mn„wtryir.r r,r .iu � <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET TOILE <br />A/C—NHNDLGUNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U.. M E.A. <br />LAVATORY ASH BASIN)UNIT <br />HEATERS—S.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK E DISP <br />VENTILATION FAN <br />' <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />--�— <br />Fl00fi DRAIN <br />MEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK SERVICE —BAR, ETC. <br />{ <br />SUB TOTAL S <br />SUB TOTAL S. <br />(% ' <br />PERMIT S <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE E <br />FOR OFFICE USE ONLY: <br />PHONY KT&VK <br />RAIL WTV49 <br />SIDE SETEACK <br />PLANC ECKNUMEER <br />FEE <br />RECENT NO. <br />L 1r (l( <br />LIVE zm <br />LOT AREA <br />VACANT HTE <br />FEES I <br />VALUAT!CN I <br />FEE <br />� <br />`] YES .- NO <br />BUILDING <br />I <br />TYK OF Omt <br />NO OF STORIES <br />OttunM;r <br />0aD' W40 u11's <br />PLUMBING <br />T <br />SRSOFOLM <br />FIRE SPRINKLERS RECTO <br />SASEMENT <br />MECHANICAL <br />I <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />i <br />OCCUPANCY LOW <br />FKIE ALARM "I <br />NE--LMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />i <br />MAKE BY FLANS APrROVEDry <br />CITY OF EVERETT <br />PUBLIC WORKS <br />' <br />-r- <br />LOCAL SALES <br />DATE <br />TAX CODE IS 3105 � <br />TOTAL <br />