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APPLICATIIC 1 FOR CONSTRUCT' IN PERMITS <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATINGSYSTEM: ❑GAS 1JELECTRIC J <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION I-.-�. COMBINATION ❑ BUILDING ❑MECHANICAL );PLUMBING SIGN <br />pµryEN u4u wonFss CITY Lv vMONF <br />?in SwAAIs0N1__ 342E Hatt EUER=,r <br />iEINNi W1N:01 .59 GtY ZIP PHGiF <br />IT <br />QEIJAISSA,ks twt.baL,, 133ob '5Q S30 NI F AELI34900 46u.J 4>f'5-1-4 904A.I(3-109 7 <br />MECIUWKl1CpITMCTOR WL AOGIESS CITY ZIP PHONE STATE UCENSEIF <br />VLWBNOLO!IiRACrIXI YAL AOORESS GTY LP PlplE STATELKE . <br />CONTN4i PacEa WORK ,�' <br />DESCRkE WORK A1q SOIMRE iCOTAOE PPALVED <br />LOHIC vER50N ANLvwPt NO. g36-554/q5/1 <br />pNF d s1Vr� LiX121 T)fLLL. C�iDpw�rOVea, <br />Owwec- \ 1 NcC A.7Ll1 cYGb+/ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO UE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/� <br />g12,A_? <br />PROFosEBusE oreunOnO <br />LEWLDESOAIfM OF vroPERTY (SHCMT1 I.LMCR ATTACH Mx COPIE% <br />Lrr�-I-�L2` eLocK �— DE _0 1 ) N <br />• <br />C9EL rA D !uueER <br />-3E=old—ovd9 -- <br />CCNSrRU.rION L/JAH LEhCE0. wCRE59, TLlEPHdIF NUN6ER <br />PROJECT ADDRESS <br />34;I,k R_,y <br />PLUMBING IMECHANICAL <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET(TOILET) <br />A/C—AMNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />a. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SEBVICE—BAR. ETC.) <br />SUBTOTAL E <br />SUBTOTAL f <br />_ <br />PERMR S <br />PERMIT S <br />_ <br />TOTAL FEE III <br />TOTALFEE f <br />PE1G rIFPICF I ISP ONI V• g 11JA w A1.J, 0 //A.✓e. / <br />FK:NTS TB <br />REARSErHALK <br />FCE SE <br />PVJILNKK MIMBER <br />FEE <br />REL'EIP Iq <br />usE ZONE <br />LOTAREA <br />I wL/ <br />V rME <br />❑ YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I 21 i2 <br />HTEIX NMI <br />_ <br />Fq aStOfIIES <br />� <br />tt[veAY.r Ao aPHumcum <br />SIZE GF Bl00/. <br />IS / IG <br />FIRE6 Rxln_SREBD <br />0 <br />BMFLENi <br />Cl YES _I NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />--F— <br />OCCUPANCYLWO <br />FFIEA URE09 <br />HE*WLYBAT <br />.45 e!�hvkl <br />OTHER <br />i <br />REASD <br />STATE BUIl01NG SUHCIUPGE <br />MIME BY <br />PLAtISA RCNEO BY <br />r{- <br />DATE <br />CITY OF EVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />TOTAL <br />