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' "'• everett <br /> QFPILICI�TIOh FOR Cl�1�STRl9�T1�M PEI�MIT <br /> TO BE COMPLETED IN INI<—PLEASE PRINT � <br /> ;ne Emrgreen <br /> CRY OF <br /> everett HEATINGSYSTEM �{GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-BR10 PLUMBING SIGN <br /> DEMOLITION COMBINATION BUILDING ?i MECHANICAL <br /> OWl� . MAILAO�RESS CITV 21FI :.. PYORE _ .. <br /> � �1 �� i�) <br /> i) , -� <br /> � � ,1 �i 1 /����, �-� � , � , � .. „ � � <br /> � � 1 I 1� ���11 � ����IY �I� ' )1 � � � � PHONE <br /> fENANT <br /> I.IAIL ADDAESS C�TV ZIP <br /> nRCHITELTOFDESIGNER MAILRO�FE55 <br /> CITY ZIP PNONE <br /> y n H �11Y Z�p PHU+E UCENSE M <br /> ��� GF.NEFAI CONTRACTOA MAIL AODRE55 <br /> (al-3 ��TY Z�p PMONE UCENSEI <br /> C�H RECHANIGALCO4TPFGTOR MAILAD�RE55 <br /> +�y��yrr+!!� PHONE LiCENSE/ <br /> H �H cLUMBING CONTRAGTOF L1hll PDDRESS CITY ZiP <br /> � <br /> � 1-3"�CJ CLASS OF WOAK <br /> ) <br /> � H� �1,NEW � � ADDITION ALTERATION . FEPAIR . DEMOUTION WOODSTOVE/FRPL INSERT .-: 6UILDING RELOCA I <br /> ��'i CONTACT PEFSON AN]PHONE NO <br /> � O pg GONTRO.CT PRiLE OF WORK V�: L�u O i n�'^� <br /> �� OESCRIBE W�AK AND SOURRE FOOTAGE���OLVED <br /> H t7 „ � <br /> o Hg ]_ � ,� ; l 1 �'.7/1� ��r ��� <br /> � � PROPOSEOUSEOF g�I�LDIN I HEREBV CER7IFV THAT I HAVE FEAD AND EXAMINED THIS <br /> „ n - � l � ' I ; APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �-�-I � � )_,_!__�/�� T�{-�> >'�'-' PROV!SIONS OF LAWS NND ORDINANCES GOVERNING THIS TVPE OF <br /> qy ��ecn��kcaiaTior+oFaaocEaJ��s�owHee�owoaa*tnc�Fouacoaies�� yyORK WILI BE COIdPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> r z �o� 9�aK o� NOT. 1-1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H H ' AUTHURITV TO VIOIATE OR CANCEI THE PflOVISIONS OF ANY <br /> g � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> H <br /> n d y PERFORMANCE GF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 6VHICH <br /> � �� __ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �. y y CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> r] �� SiGNATUAEOF�ONiRAC'ORORAl1iHOAiZEOAGENi DRTE <br /> .. � ��1� f;�. � I �'1 a /' ;,�� 0 1 �i' <br /> ,i �'i,�_i� '% <br /> vROJEGT�IA00Pf�55 i noP�iC�NTSQivBUANE55UCE�+SENO ANDBUSiNE55NAME <br /> IL� iP 1 �r�l��l �'�) 1'-��� _ .�' � �:,. .� I ,� <br /> MECHANICAL <br /> PLUMBING FEE <br /> �, � NO. TYPE OF FI%TURE OR ITEM FEE NO. A C—A�HYOLG OF7g uH P ENT <br /> � � WATER CLOSET(TOILET) _ , FORCED AIFi S`.'STEMS—B.T.U. M E.A. <br /> �LAVATORY(WASH BASiN� � UNIT NEATERS—B.T.U. M <br /> ' w. SNOWER GLOTHeS ORYERS <br /> �� KITCHEN SINK 8 D!SP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> �r, � IAUNDRY TRAY <br /> WATER HEATER <br /> I � CLOTHES WASHER WOOG STOVE <br /> � UR:NAL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> ���ar� FLOUR DRAIN HEAT PU1dP <br /> ����' BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SEFVICE—BAR,ETC.) <br /> pw "� <br /> � <br /> �B I SUB TOTAL 5 --6UB TOTAL 5 � - <br /> PERMIT 5 —PERMIT 5 �,-. �'\ <br /> - TOTALFEE 5 �TOTALFEE 5 =; i � � <br /> � FOR OFFICE USE ONLY: RECEiar No <br /> GRONTSEi8r1CN �cARSET�ACN SIOESETOACN PLRNCHEGKNUMOEA FEE <br /> usezor+e LOTAPEA VRCANTSITE FEES VALUATION FEE <br /> BUILDING <br /> tvrEO�LONiSRLlOW4BlE T�PEO�CONS'AG�U0.l aC.o�M� NOo�o'.�'����wG'.si15 � <br /> caauo P�UMBING <br /> 52[OF BLDG NO OF STORIES BASEMEN7 MECMANICAI �"V <br /> OGCUPANCY LOA� FIRE SPRNNLERS REOD NE�GNT LIMI!ATION <br /> ADDITIONAL PLAN CHECK � <br /> OTHER <br /> i <br /> REASON FOR S�AINNlERS <br /> STATE BUILDING SURCHAflGE _ <br /> iNine[BY PlRNSI.PFROVE�Bv CITY OF EVERETT PUBL�C WORKS � <br /> LOCAL SALES ,r�-�( <br /> TAX COOEIS 3105 �OTAL <br />