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�4PPLICAYla.1 �OR CON�TRUCT.JN PEF3lIill7° ��t'«'" <br /> neE�e��u,��� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv or � <br /> eve rett I HEATIMG SYSTEM: ❑GAS U ELECTRIC L; ____—__-� <br /> BUILDING DEPARTMENT <br /> � 259-8810 <br /> DENIOLITION COMBINATION BUILDING MECHANICAL �LUMBING SIGN <br /> O't:':GH 1AAILADORESS QTY ZIP PHONE <br /> ���=�r�t� �1 E l�r��'�nti I�(-z L[���,A � .� �V � �(f3�Ol ���.�� <br /> lElinNi �dNLADORESS CITY ZiP PHONE <br /> nFCHIi[GTOROESiGNER MARAODRESS CITY Z�P CHONE <br /> F]O H GENEFlAL CONTRFCTOP IAAIL AODP.ESS GtY ZIP PHONE UCENSE• �,V QJ <br /> ��� �JAS� N4�T I�A�S �v 11 8 S� t�s i n1F1�-� �� �I���C' tiSS-3�3c ��Asrlt�c�a£�scP, <br /> ��� 1.'�[Cib1NiCALCONiRACiOR MAILADCRE55 CIiY ZIP PHONE UCENSEa <br /> C H <br /> 9yxby PW!1�iNGCONifi�CTOR IANLADDRE55 CiiV ZIP PNONE IICENSEs <br /> y Z t�-+ <br /> F� C7 G1A550F1YORK <br /> y� � NEW ADDITION ALTERATION � REPAIR �EMOLITION WOODSTOV6FRPL INSERT .. � BUILDING RELOCATION <br /> � H� 1 n1 V � LOtlTAGT PERLCt!AIlO PIIONF NO. <br /> y y r GONiRACT PRICE OF YJORK 1 �o� <br /> Mz� OESCIIiBE WJRNM��SOUAR[FOOTnGE RJVOWE� <br /> � H d � �4�S F� � � (' <br /> ;U C'� P��OPOSFDUSEOP�WLDiNG I HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br /> ��� �r�� APPLICATION AIJD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> q e�cn�oescnia.ioNOFrnoa[arrisNowr+ee�owoanrrncHFouacor-ies� PROVISIONSOFLAWSANDOROINANCESGOVERNINGTHISTYPECF <br /> z H 3 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREiN OR <br /> � y z ior__ o�oce or NOT. THE GRANTING OF A PERMIT OOES NO7 PRESUME TO GIVE <br /> H H AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> l� �H OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n d y PERFGRh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 3 �� �Y����l/�7� O��`I -��l ' U�D7 qaPPLICOFOT�ISSROA�ET ANDPE CnM'P Y EWITOHKTHOER STATE <br /> LT1 <br /> z y y CONTRACTORS LAW 1827 RCW AND 29E200 WAC. <br /> y ��p iiGNATIIREOFLONiRAGTORORAUT�i0Ri2EDAGEI.T DAi[ <br /> PqOJEC�A0DRE55 �� / � -— <br /> D� � q 1 n�4''y,/ � SCrtVflWiNE55LICENS[NOAf:O USMESSNAIdE <br /> li U <br /> PLUMBING MECHANICAL <br /> NO. TYPE O.'-FIXTURE OR ITEM FEE NO. TYPE C�F EOUIPMENT FEE <br /> '^" `o WATEP CLOSET(TOILF.T� ��C-A�HNDLG UNiTS-H.P. <br /> ��' �ATHTU6 FORCED AIR SYSTEMS-B.I.LL G7 EA . <br /> LAVATOFY�bVASH BASINI UNIT HEATERS-B.TU. M <br /> ,e.,, � SHOWER CIOThIES�RVERS <br /> p a KITCHEN SINK 8 DISP VEN i ILATION FAN <br /> � � DISHWASHER RA;J3E HOOD <br /> LAUNDFi1'TRAY WATEP I IEATER <br /> �' � CLOTHES WASHER WOOD STOVE <br /> !�� URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � FLOOR DRAIN � HEAT PUMP <br /> I ,� � BACKFLOW PREVENTERS ; GAS PIFING <br /> ��� ROOFORAWS-R.4INLEA�ERS —�— EXHAUSTFAN <br /> SINK(SERVICE-BAR,ETC.) <br /> E� �.f — _— i <br /> � <br /> I y9 SUBTOTAL S SUBTOTAL S )rj ; �'" <br /> a..c;� - <br /> PERMiT S PERMIT 5 J rj ; o0 <br /> TOTAL FEE S TOTAL FEE $ � � i c o <br /> �> FOR OFFICL USE ONLY: <br /> FRONi:EiOACK RFARSElOACK Sp[SLiF1ACK PLAtlGI[CNllUAlpkR GfE �[CEIPTNO <br /> usem�+e �oranen vncnnrsire FEES VALUATION FEE <br /> BUILDING <br /> �viCOfCONiSAILOWA9lE lYPE0FC01lSi.ACiIIAL occu>uiw rvoIXowuuauw�ns <br /> �"a'° PLUMBING <br /> tiilEOF9LOG NOAFSiOPIES BASEMENT MECHANICAL � <br /> or,cuanNevlonv FweSPRNrcleaSFe�o MEiGHtu�.�rtnnor+ ADDITIONALPLANCHECK <br /> i <br /> OTfiER � <br /> RFny04FOPSopINNLERS --- --� <br /> STATE DUILOING SUflCHARGI: <br /> i;ltnnli[iY PLANS�PPfiOVCD�Y CITY Of EVERETT PUBLIC WOFiKS �� <br /> LOCALSALES <br /> TAX CODE IS 3105 TOTAL <br />