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,;:�, _ <br /> �. <br /> � <br /> APP{LICATIC�"`J FOR CONSTRUC'Y"���H1 PERMIT ���� "`� <br /> ;� <br /> TO BE COPdPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ' � GAS iJ ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING XMECHANICAL �PLUMBING SIGN <br /> OWNER MAILAO�RESS �C1ITv 21P PHONE <br /> �YV Il � � 1 / q Yf �.� n � /��i.�.. O /��� . �� o <br /> im I �/�l Fic��'���'��i� c c;z�f �r ; �,�.,� . � ,-s � �� �/ 7 <br /> TENANT �d/+ILA�DRE55 CITV ?IP PHONE <br /> ARCNITECiOF�E5IGNER MAILA��RE55 CITY ZiP PHONE <br /> ��H� GENERAL GONTRAGiOR 61AiL�DDRE55 CITY ZiP PHONE STATE IICENSE e ' <br /> y UECHANICALCONTRFGTOR fAAILADORE55 C�iV ZiP PHONE STAiELIGRlSEx <br /> x ! / / /� <br /> � H �� ��LI-�fr7'li�r' Tn� �Y�`���f"��C�Cll�i��/ �G'r �"fT/ n1 �.�L'/ �i���^/ �N�Nf.4'S'�'l��r,C��� <br /> ayN PWM9INGCONTRAGT F MARADDFE55 � CITY ZIP PHONE ST4TELICENS[a <br /> /� �� �� I � �� /� <br /> y �i-�i <br /> FC y� CLA55OFWORK <br /> NEW . ADDITION � ALTERATION REPAIR DEMOLITION WOODSTOVE�FRPLINSERT BUIIDI�lGRELOCATION <br /> "�� H'i1 <br /> I /� CO . PERSON AN�PNON 0 ` / <br /> � <br /> y �� CON�P�CTPqICEOFV10RK h ����,/�_ /��,L� `J_ �� <br /> �� n� OESCPIBE WOPH AND SOUARE POOTAGE iN`IOLVED <br /> �3 <br /> O H _J LL'��K! P (�(1 ;�� I��F � Lj� ����'�f /o'h _ <br /> � C�C PR oseouseoFeui�ort j'� / /) i hIEREBV CER7IFY THAT I HAVE READ AND EXAMINED THIS <br /> G]�n ����� �_ /�-" ./�.m . / ( � APPLICATION AND KNOW THE SPME TO BE TRUE AND CORRECT.ALL <br /> H � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGAL�ESCRiPTIONOFPBOPEFNI5H01VNBELOWORAit CHFOURCOP�ES <br /> x y WORK WILL BE CO�dPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �'y Z �ot e�ocn oc NOT. THE GFiANTING OF A PFRMIT DOES NOT PRES'�IME TO GIVE <br /> H H /� �{ 7 �y � /r� AUTHOflITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> g y N �/T(��t�n�'�'7.J 9"���J—�t-,�J "��L�v% OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> p ty y — "`I"'-- PERFORtdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � C ty OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> ���a� [zJ APPLICATIOP! IS IdADE AND I CO�dPLY WITH THE STATE <br /> 'L' H V1 CONTPACTORS LAW 27�i AND 296200 WAC. <br /> HOV� , <br /> . ....._ . I�,� / ��� � <br /> � <br /> PROJEGTAD�RES �r � �'�^��•' ' unif. <br /> � C���/� i L� " � Cr� r.�,n.;s-.i ss:��cr.sc i.n � . <br /> P UMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> ��� WATER GLOSET(TOILET� n�C—A H��LG UNRS—H.P. _ <br /> �►� BATHTUB _L FORCED AIR S�STEMS—B.T.U. M E.A <br /> LAVATORY(VJASH BASIN) UNIT HEATERS—D.T.U. M <br /> �^ SHOWER _� CLOTHES DRYERS _ <br /> I � KITCHEN SINK 8 DISP VENTILATION FAN <br /> �� DISHWASHFR RANGE HOOD <br /> LAUNDRV TRAV WATER NEAiER <br /> CLOTHES WASHER —� WOOD STOVE <br /> �s URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> —T <br /> � FLOOR DRAIN HEAT PUMP <br /> I `� BACKFLOW PREVENTERS ; r GAS PIPING <br /> ROOF DRAINS—RAINLEADERS —� EXH�UST FAN <br /> SINK(SERVICE—BAR,ETC.) ' <br /> te ' --_T . <br /> .^ _�2. <br /> _ � <br /> _ � <br /> I '�� SUB TOTAL S ' SUB TOTAL S <br /> PERMIT 5 ?— PEFMIT S <br /> TOTALFEE 5 TOTALFEE 5 <br /> �- FOR OFFICE USE ONLY: <br /> FRONTS[TB�CK REARSEiF1ACK SIpES[10AGK PInNCHF.CHNNAfIE11 FEE RECEIPTNO. <br /> ��9—�3 <br /> usezor�e �ornaen vncnN.sirr: FEES VALUATION FEE <br /> BUILDING <br /> iV{'E�P G@!B.AlLOYlABLE iYPE 01 CON51 AGIIIAL oeeur.i.n po oi owuue,�ur:ns '--�-- <br /> wcur � pWIdBING <br /> SIZE OF OL�G. IJO.OF STORIES DASEMENT NECHANICAL <br /> OCCUPANGYLOAD FlRESPRNHL[RSRW'0 HEIGHTLUdITATION ADDITIONALPLANCHECK <br /> SPRINKLER <br /> R[450NFOBSPRINKLERS <br /> STATE BUILDING SUfiCHAPGE <br /> �r„nKe o� — r�nr,s n��noveo uv CITY OF EVERETT PU�LIC WONHS <br /> LOCALSALES � <br /> TAX COUE IS 3105 TOTAL � <br />