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� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> a/ ' � <br /> � - D � nrtil� 7 <br /> BUILDINQ DEPARTMENT , HEATING SVSTEM: GAS �ELECTRIC `j <br /> 259-8810 ` <br /> � D��ON ❑ COMBINATION 19 ige4 L� <br /> O BUILDING MECHANICAL '-•• 6UM81NG p SIGN <br /> C p m <br /> � ����5 1�� G�e�� �ron� � �"`, . �,� ETL <br /> "I cm nv r�oHc �J <br /> p10[MONER MAILAGWIFN <br /> C�TY jIP <br /> P/Ip1K <br /> �ADO� em — <br /> z�r <br /> ��� iTAT��(� � <br /> WINOMq G <br /> , '� tw <br /> tr � <br /> !lwrio ra� ►w�oonEes <br /> • air :iP <br /> P�E BT�'TIIC N8E1 <br /> MMCt p�M711K . <br /> A14�OIA11r Ap�MVOW[0 <br /> . .. . ACT►E ANO Np. <br /> l� � <br /> �� ��►� i HEREBY CERTIFY THAT I HAVE READ ANO EXAMINEO THIS <br /> PROVISIONS OF UWS ND OROINAPICES ppyERN NO TH SRTY E OF <br /> udLL OLM:M1qN OF MIORflTY(N10W11�LIOW p1 ATTACII lYq COIKB� <br /> �� a NOT. T E'LORA T�p OF A PERMI7 DO SENOT PRIESUMEETO QI�VE <br /> �►ouc <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISION8 OF ANV <br /> OTHER STATE OR LOCqL LAyy qEpULATINp CONSTRUCTIOry pq 7�E <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOq WHICH <br /> ��T��'�'M�� - APPUCATION IS MADE AND I COMPLV WITH THE BTATE <br /> CONi ORS . .27 qCW AND 2DORpp yyAC. <br /> � R ts.iRt � <br /> . <br /> ?RQIECT ADDII[Sf <br /> 5 <br /> � WTl <br /> FIUMBING �"•�^h��vs i r.rMtr r�o <br /> N0. • TYPE OF FIXTUqE OR REM MECHANICAL <br /> WATER CIOSET TOILE FEE NO. TVPE OF EpUIPMENT <br /> A/C—A/HNDLG UNIT$—H.P. FEE <br /> BATHTUB � � <br /> UVATORV AS BASIN) FORCED AIR SYSTEMS—g.T.U. . M E.A. <br /> SHOWER ' UNIT HEATERS—B.T.U. M � <br /> KITCHEN SINK 6 DISP CLOTHES DRVENS � <br /> 018HWASMER VENTILATiON FAN , <br /> L'+UNDqV TRAY � RANGE H000 <br /> CLOTHEB WASHER ' VVMTER HEATER � <br /> URINAL ' w00D STOVE � <br /> DRINKIN(i FO�NTAIN � METAL FIREPLACE�WOpD BURNINp <br /> p�ppq pq��N � FIREPUCE INSERT , <br /> BACKFLOW PpEVENTER3 HEATPUMP ' <br /> ROpF DRAINS—RAINLEADERS GAS PIPING � <br /> SINK SERVICE—BAR,ETC, ExHAUST FqN <br /> � , <br /> � <br /> � <br /> � , <br /> � <br /> � <br /> � <br /> � , <br /> SUB TOTAL f � <br /> PERMIT s SUB TOTAI j � <br /> TOTAL FE'c f . FEFMIT s � <br /> FOR OFFlCE USE ONLY: T°�a�rE` ; � , _ <br /> f110NT�tTMCK 11EM�ETMCN 61DE7ETMCIf <br /> rWICNECKNVMlEp FEE IIECEDTNO, <br /> ��R IOTAqE� VACRKT,^�ITE . <br /> ,_ YES ;_ NO FEES VALUATION FEE <br /> 1M►FpWNf[ rq.OFiT011KY BUiLDiNG . i <br /> � �oaorrt�urcurn� � <br /> ��K� PLUMBIN6 � <br /> ������ MSEMENT i <br /> O VES ❑ NO MECMANICAL , � <br /> �'�� FM1EhLMM11[pp 11�qNT�iy�T�TqN ADDITIONALPUNCHECK • , <br /> i <br /> ��� OTHER � <br /> . i <br /> � <br /> ��� STATE BUILDING SURCHARGE ' � <br /> "�"8AMR0V�0� CITY OF EVERETT '' ' <br /> LOCAL SALES PUBLIC WORKS � <br /> �"T� TAX CODE IS 3105 Tou� � <br /> � <br /> ; <br />