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/�lPPLICATIC ! �rOR CONSTRUCT 'N PERMIT i;� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��err <br /> BUILDING DEPARTMENT �HEATING SYSTEM: �,J GAS U ELECTRIC G_________._� <br /> 259-8810 <br /> DEMOUTION � COMBINATION BUILDING '. '' MECHANICAL I : PLUMBING i I SIGN <br /> 04VNEfl M114�LA���ESS LITY 21P PMONE <br /> �n R LA 51�i3 Roo� /y�2o� S�Y� 5t N� ��ST�S 335 S6S/ <br /> iEII�NT n�AILAO FES� CIiY 21P �'��ONE <br /> � <br /> .�NGHiiECTORDE5IGNER MyL�DDRE55 CrtY ZIP PHONE <br /> n�� <br /> y c�r+ _ <br /> r�J c;^�LB4LCONTflAGTOR MAIIADDRESS CITV 21P PMONE SiAiELtCENSEt <br /> �'a y l�t/F}/.KE,2 �pNSrRc.cc r—ion/ ,�Z �37 5``Sw r�f.�k���e� 953-/5�/ wA�Kc.c� /�zKa. <br /> `��"' "i.CMANICRL CONiRACTOR MAIL ORE55 CITY 2�P PHON[ StAiE LiCENSE� <br /> ayv� n� <br /> > �'IUY.C�NGf,ONiRACTOR AIA�AOD�E55 CITY ZIP PHONE SiAiEL�CENSE♦ <br /> K z� �/4 <br /> �-7� cov��r+n(c�T�aiceorwor+K ��y� <br /> '�zJ H'� •�!� �"�C� 1NCLUd�' Y./' .,� !<✓yap.��..� Y11�� <br /> y y� OESLRipE1VORhPNDS:]IIAnEfOOiAGE�NYOeLV ���--v� ���iNbl �CCIInCT'P€PSONANDPNONENO. �57� ///�/ ���� <br /> � o� _srR.i� �jZRmE . �ry ,,-`�.nP`'fi -� r <br /> H� (�181N6'�$ WINDou+ <C.T, C�u.N,bl/y� TIZIN�oNLy) <br /> o F-+�y ��m ec.�tn n_�c� e.o�+ p� l�ee� <br /> r�-+ t�i0 S++�E rnE.ufnN�ui �.(pie: ONLy �RN1R6� <br /> C,�� C� .'�(;.�}-l-£(�,� i HEREBV CERTIFY THAT I HAVE FEAD AND E%AMWED THIS <br /> H ruoros use ov em�oivc APPLICA710N�VD KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> a y �E$�,Dre-N,'r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> t'� H y ic�;n�nescaiPnor�oFvnovearvis�wwNoe�o��vonnrTnu�*r:o�.::>-es WORK WILL BE COMPLETED WI7H WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PER�diT �OES NOT PRESUM17E TO GIVE <br /> y H LOT - °LOCK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 7 C1 f/� OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> aa +s FU(_Ta N �VEP _'(T' <br /> PERFORAtANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> LTJ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> y �y - APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> ��,:r..ce�tn.i o r+cu.oer+ CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CC:SiRUCTION LOPN lB��[P.ADOBE55.TELE�'HON[N�IR��f�� <br /> .�/sura.+n.c� X�� C, _.�-a -93 <br /> PROJECTADDRESS �' u•'E <br /> r��/�� ��6� ( /.•.�� -•,��.� <br /> PLUMBING MECHANICAL <br /> f.� ` N0. TYPE OF FIXTURE OR ITEM1t FEE N0. TYPE OF EQUIPMENT FEE <br /> .��I _ WATER CLOSET(TOIL[T1 ____ __ �C—A HNDLG UNITS—H.R _ <br /> BATHTUB FORCED AIR SYSTEIdS—B.T.U. M E.A. <br /> LAVATO�IV(VJASH�ASIN) UNIT HEATERS—B.T.U. M _ <br /> ��� _ SHOWER CLOTHES DRYERS � <br /> �"`+ KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUN�RY TRAY Y/ATER HEATER <br /> .�� CLOTHES WASHER WOOD STOVE i <br /> URINAL METAL FIREPLACE�WOOD BURNING) � <br /> ORINKING FOIi?:TAIN i FIREPLACE 1 T <br /> FLOOR DRAIN HEAT PUMP <br /> �' ""' BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEA�ERS � EXHAUST FAN <br /> �F . ' SINK(SERVICE—BAPL ETC.) ; <br /> � <br /> �'''� SUBTOTAL 5 SUBTOTAL 5 <br /> PERMIT 5 PERMIT S <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> ffIDNi5E10ACK RCARS[TOACK SiDE5ET0�CK FLANCHECNNUI.10[R�� ffL FCCF.iPiNO <br /> �� <br /> US[IONE IOTAREA VRCANTSITE FEES ��ALUATION FEE <br /> ❑ YES (1 NO EIUILDING � � <br /> t�iEOfGON51. NO.OFSTORIES acun.ncr newrouu•.:v,ns — -- —�� <br /> �0°P PLUfd01NG � <br /> Sit[OFBl06. FIRESPiiINKLEfI5flE09 B�SEMENT MECHANICAL <br /> n ves ❑ No ---- <br /> oCCUPANCYLO�D FiREAURMREO'0 NEIGMiUM�tAT1orJ �DDITIONALPLl.NCHECK � <br /> OTHER ' <br /> i <br /> i�F�50N — <br /> STATE BUILDING SURCHARG[ L/��i <br /> � <br /> winH[OV Vl�NSAPPROV[DOY CITY OF EVERETT Pl19LIC WORKS � <br /> �ocn�sa�es ' <br /> DATE TAX CODE IS 3105 rora� 3 � Z �� �) <br />