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APPLICATIC ) FOR CONSTRUCT' �N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br /> / <br /> BUILDIPJG DEPARTMENT � HEATING SYSTEIA: � GAS � �ELECTRIC J � <br /> 259-8310 =-- <br /> DEfdOLITION COMBINATION ��BUILDING �ECHANICAL n <br /> °L�",���� r.+na nooaess � /J y LUMBING <br /> _Y%1I.,, . ,.� n 7 .!�' - Y �/ � zi� °"°''� SIGN <br /> �._inr�r �1L�� ��G, .i- 9 �S>/C .11� � � �/ <br /> lAAILADDfiESS ����Y�—y-��TY `� ����i T� <br /> Z�P PHOJE <br /> AFCHITECTOqDESIGKER MAILAD�RESS <br /> CITY Zip PHONE — <br /> GENERA�CONiqqCTOR ldqlLpDORESS <br /> CIiV ZIP PHONE <br /> STATE LICENSE n <br /> '.t[CHANICALCON1qACT q Id41LADpRE55 <br /> ����//�p����y� � A�� CITV Z�p PHONE <br /> --'-1=31... . JIL� SiATELILEhSid <br /> �'LUTA(31NGC0.'IiRACtOq !1 OORE55 <br /> pTY ZIP PMONE <br /> STATE LICENSE< <br /> CONTRACTPFIICE PY;OBN <br /> i>c"SCR�P.E R'ORK SOUARE FOOtA INVOWE� ��_J•�� <br /> _� c CONTACTPERSONANDPH04LN0 - <br /> � <br /> — _QiT� l � � <br /> ���oPoseouseoFeuaowc i HEREBY CERTIFY THAT I HAVE RFAD AND EXAM17WED THIS <br /> APPLICATION AND KNOW THE SAME TG�E TRUE AND CORRECT.ALL <br /> �ecn�oescaiPnorioFaaoaeArv�sHowNee�owonnrrncHrnocories� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COlv1PLETED WITH WfiETHER SPECIFIED HEREIN OR <br /> 1�OT e�ocK oF N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL 'fHE PHOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATMG CONSTRUGTION OR THE <br /> PERFORM1IANCE OF CONSTRUCTIOIV.THAT I AM AUTHORIZED BY THE <br /> OWNE(i OF THIS PROPERTY TO PERFORM THE WORK FOR VJHICH <br /> aaaceirnx�o.rvun�oen -- APPLICATION IS MADE ANO I COMPLY 'NITH THE STATE <br /> (� `^ �—D� _ CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTIONl04NLEN[IER.A�ORE55,T[LEPNONENl11d0EP �_ /�����J / <br /> � ///� � <br /> PROJEC7 ADD ESS�.. <br /> v�7�� '!{�iiz.p�, �/z���- <br /> � � � s�� <br /> unrc <br /> PLUMBING iu„v�s_u,.�,.,� ,o ..- <br /> NO. TYPE OF FIXTURE OR ITEM FEE MECHANICAL <br /> N0. TYPE OF E�UIPMENT FEE <br /> WATEfl CLOSET(TOILET� � A'C—A�HNDLG UNITS—H.P. <br /> BA7HTUB FORCEDAIRSYSTEMS—B.T.U. �M E—. — <br /> LAVATORY�VJASH BASW) --- �� A� __ <br /> SHOWER UNIT HEATERS-8.7.U. M <br /> KITCHEN SINK&DISP CIOTHES DRYERS _ � <br /> - — VENTILATION FAN <br /> _. __ DISHWASHEF RANGEHOOD � <br /> LAUNDRYTRAY <br /> -� -- i WATER HEATER <br /> CLOTHES WASHcR WOODSTOVE <br /> .__ URINAL ; ME fAL FIR[PLACE(WOOD BURNING) —T— <br /> _ DRWKING FOUNTAIN FIREPLACE INSERT <br /> _ FLOOR DRAIN HEAT PUMP - � <br /> BACKFi_OW PREVENTERS GAS PIPING -�— <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN — <br /> �INK(SERVICE—BAR,ETC.) � _ <br /> __ . ---- --:--. <br /> T <br /> . SUB TOTAL S SUB TOTAL g <br /> PERMIT 5 PERMIT g <br /> TOTAL FEE S TOTAL FEE g �— <br /> FOR OFFICE USE ONLY: <br /> �'R04i SCTBACK REAH ScT9ACK SID[SETpAGK � <br /> PVdif.H[CKNUM1I6Efi PE[ qEf.E�PTNO <br /> — // <br /> .���2ZONE LOTAREA VAC�NTSItE <br /> FEES VALUATION FEE <br /> �.�: YES .--. NO <br /> . ^�COMSt N0.oF S70RIE5 BUILDWG <br /> occuva!:cv r:oore:,E.,..:�,m.',rs —.__ <br /> r,ncuo --— — <br /> -— P'"MBING <br /> � ��"��-����� FIqESPRMKLEflSREO'D BASEMENi <br /> .=i YES .� NO ���CHaNicq� � <br /> O:;WPANCVLOAD FIREALq�1MREOD HLIGHiWdITAiION ADDITIONHLPLANCHECK <br /> �1cn50N OTHER <br /> STATE BUILOING SURCHARGE �— <br /> r,r,,Ke�v a�nrvs aaraovro ev CIiY OF EVERETT — — <br /> LOCpL SALES PUOLIC WORKS <br /> on.e TAX CGOE IS 3105 TOTAL <br />