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�� <br />APPLICAT10�1 FOR CONSTRiJC'T�1N PERMIT /,;✓� <br />TO HE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ —� <br />259-8810 <br />!J DEMOLITION !_1 COMBINATION ! I BUILDING ❑ MECHANICAL Ci PLUMBING �SIGN <br />OWNER MAILAOORE55 CIT�' ZIP PMONE � . <br />���{_� G�r..fr�ic_!2 �=1 A'L � :/�,-! 7LL= ."l,`� IO / �J`I �—��='�1 `, <br />��I� ; +Fz�� -nu� _;:-- s <br />TcN��+T ' MNLA��RESS CITV ZIP PNONE <br />-ff1�?I7_7 �J F;,C.1�; K 1 i�/�-��Z' ti A�4�L-L % E_� � r'C�-�� a,�. �J �. rT 9� z ZL� <br />ARLMIiE��lOR�ESIGNEP MAILA�CRE55 qTY IIPzC��,�;���{C�IIE�� <br />(��(_`(�, i�IC^rJ C_� 3k�s f ff�ltJ N�-�'r,4 rJ 2.D Y>il.nr;a �;'/. ��3«,c; �1X��-SK� n77 � C� <br />IdECH4N'JAL <br />PLUMBI��G CONTR�CTOR <br />CONTRACT PRICE OF WORK <br />n+aa aooaEss <br />IAAIL AD�RE55 <br />�7 � � �' � �^�: � <br />�ESCRI9E WORK AND SUUARE FOOiAGE INVOLVED <br />-7 ; v�� �.v� �c� srhr� � <br />PfiOPO EDUSEOFBUILDING <br />��•NK <br />LEGnL �ESCRIPTION OF PFOPEflP: (SMOWN BELOW OR ATTACH TWO COPIES� <br />LOT--- BLOCK OF <br />�TRCEL TAX LD. NIIMBER <br />LENDER.AOORESS.TELEPHONENWABER <br />� �,;e� rr n.9 A�u_ � <br />PLUMBING <br />NO. <br />BATHTUD <br />LAVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DHINKWG FOUNTAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADEFS <br />SINK ISERVICE—BAR. ETC.1 <br />SUB TOTAL <br />PERMIT <br />FOR OFFICE USE ON!_Y: <br />FRONTSETB�f� �- REAJ�SE_TOACK //� <br />A <br />. <br />[��i T <br />IISE ZONE LOT AREA <br />f/ � <br />iVPE0FC01lSi. NO.OF�'OHIES <br />SRFpF�LDG. , FIRESPRI�s�cPSREO'D <br />OCCUPANCVLOAD <br />INTAKE BV <br />FIRE AU1RM REO-D <br />PLANS APpFi�yED BV <br />DFTE J��,���1_ti� <br />CITY 21P PHONE STATE UCENSE I <br />CITv 21P PMONE STATELICENSEa <br />GITY ZIP PHONE STATEUCENSEA <br />CONTAGi PERvON AND PHONE NU. <br />•� � c:k= ���v-srl-1-/ i ��:_ "1_� ; '% �;. 3 =� <br />I I�EREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AtJD ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE CGMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES P10T PRESUME TO GIVE <br />AUTFIORITY TO `/IOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOFMANCc OF CONSTRUf:TION. THAT I AM AUTHORIZFD BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CO�dPLY WITH TF(E STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X�r'����� /%--� �I�r� �'3 <br />�� „� <br />Ciiv F'JSiNE55liLE15E N9. <br />MECHANICAL <br />FEE NO. TYPE OF EQUIPMENT FEE <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIFl SYSTEMS—E.T.U. M. EA. �_ <br />UNI7 HEATERS—B.T.U. M <br />' CLOTHES DRYERS r— <br />VENTILATInN FAN <br />RP.NGEHOOD —T-- <br />' WATER HEATER <br />� VJUOD STOV= <br />METAL FIFEPLACE (WOOD BURNMG) � <br />� FIREPLACE INSERT . <br />S� <br />$I�ESET�4CK <br />� <br />VP^,ANT SITc <br />❑ YES ❑ NO <br />M'CJPANCY HO OIGWfLIIAGI1N115 <br />ceauv <br />9ASEMENT <br />❑ YES ❑ NO <br />NEIGHT l IMITATION <br />CITY Of EVERETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />GAS PIPING <br />EXHAUST FAN <br />BUILDING <br />PwMaw� � <br />AIECHANICAI <br />ADDIT;[?NqL PLAN CHECK <br />OTIil:R <br />STATE (iUILDING SUP.CHARGP <br />PUFLIC WORKS <br />TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE S <br />Fj��. /��J�c�� <br />�N <br />n <br />� <br />0 <br />