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A?PLiCATI� � FOR CONSTRUCT; 1N PERMIT �✓�" <br /> �)r�, <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> I 1� ' — —' <br /> \ <br /> BUILDING DEPARTMENT f HEATING SYSTEM: J GAS k{ELECTRIC J ____,_ ____ <br /> � <br /> 259-8810 <br /> DEMOLITION I COMBINATION BUILDING �MECHANICAL �PLUMBING SIGN <br /> �o•nEn r.+ �noor�ess citv ziP v�c�ve <br /> ��N Leo� ar� � �F��`C ��� si E�er�Tr 43ao3 :�5a-� i��}- - <br /> 1ENANT L�NLADORESS G�TY ZIP PI�OK[ <br /> nqpMITECTOR0E51GNER 61FIlADDRESS CITY ZIP PNONE <br /> G[NERnLCONiRACTOR �dAILADDRESS GTV Z1P PHONE STATELIGFNSEb <br /> S1E.����L�T^AAOTGR /��;.�A^�D�RE55 CITV — ZiF PNOhE SiATELICENSEe <br /> � dJ <br /> i iii I' .r i <br /> PLlj1.101�RnCTO�iI "��OIAOORE55 D � sT � �e2��tq�ao3H�d��`l TATElIC�1�s����� <br /> v w ,� �.v <br /> corvinncr a ,ce or wonK <br /> �DD.D d <br /> �E:S�FIPFWOfiK�Np�U�fiEFpoTIGEINVONEO CONiACiPEHt�1L1NDPNONENO. <br /> �, 5 q LL � 5 �'�Q� I"DY.7 P?¢ <br /> ;� o �Iv F a o ' oF_— <br /> a� . � <br /> ( i HEREBV CERTIFY THAT I HAVE READ AND EaAMINED THIS <br /> ri.s�o use oF om�oiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OADINANCES GOVERNING I�NIS TYPE OF <br /> iecn�oescnirna+orenoPenrv�sNowNo�iowoanrrac�{twocoaies WORK WILL �E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �L� �[�Q4 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior � [��ock oF `L rYl S I AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> roQ�s��aaK�dd;+��n +o F���e�� �� OTHER STATE OR LOCAL LAW FiEGUTATING CONSTRUCTION �R THE <br /> ����.n�.�Ot��-1�7��-���e-��j.,�V���— PERFOR\7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 6Y THE <br /> D Ct�ttE oF'P�R 1$ PPr�j� SS,I$DIC[�Sp� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR W41CH <br /> ��pppyH�-Sh�,�u.iy$r-I-(�U.-F_ APPLICATION IS MADE AND I COMPLY WITH THE 5T,\TE <br /> c�inx i o.Nun+oea CONTRA ORS LAW 1827 RCW AND 296.200 WAC. <br /> � 495 -0oo- ► la — �ool <br /> CONS��UCTION IOAN LEN�ER./.DDRE55.1ElGPNONE NU6IBEH ' �L � �J� /A_!(J_�� <br /> x 7'���Lf��J �6 7 <br /> PROJECTADDRESS =�"+>r��- n� - n>�r <br /> envouseiesso...v;•� eo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(701LET) A�C—NHNDLG UNITS—H.P. � <br /> BATHTUB FORCED FlIR SVSTEMS—B.T.U. M E.A. _ <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—e.T.U. M � <br /> �-- <br /> SHOWER CLOTHES DRYEHS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATLR <br /> CLOTHES WASHER W000 STOVE <br /> URINAL METAL FIREPLACE(WOOD�URNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> r— <br /> � FI.00R DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DFlAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVIGF- BAR,ETC.) _ � <br /> — —— <br /> T <br /> I <br /> 1 _ T <br /> SUB TOTAL S ' SUB TOTAL S �' <br /> PERMIT S --� PERMIT 5 ___J�_ <br /> TOTA�FEE S TOTAL FEE S �' 1 ' <br /> FOR OFFICE USE ONLY: <br /> PRONTSF�CACH REARSLIINCK 51�[SEi�ACK PL�NCNECkNUdAE1i FFE HEC[iPfNO <br /> ust_zoNe LOTAREA VACANTSrtE FEES VALUATION FEE <br /> �-, YES ._� NO BUILOING —�— <br /> I��IlOfLONSi. NO.OFSiORI[5 octuvx4tt tnn�ann.r'.;w.rts - -- <br /> L90LP PLUMBING <br /> S12FOf01.DG. FIRESPRINNLERSBEOD BASEMENT � <br /> MECHANICAL ' <br /> _-� YES .��. NO — '—' <br /> OCCU�'�NCVIt'AD FIREALARhIREOD I NEIGHTLIMITA710N ADDITIONALPLANCHECN — ; <br /> OTHER ' <br /> nE�tioN �— <br /> STATE BUILDING SUFCHARGE � <br /> imaHr ev r�nNsn��rr�ov�uuv CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES —�— <br /> �n,� TAX CODE IS 3105 TOTAL <br />