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BUILDING DEPARTMENT � <br />25�-8810 <br />�EMOLITION i: � COMBINAT.ION <br />.,..,.� R ..... .'_'_"_ <br />HEATWG SYSTEM: J GAa �J ELECTRIC ��J <br />�BUILDING I�MECHANICAL JPLUMBING I SIGN <br />/!�- f (%R %�5 PHONE^) C� �J <br />,i'::,�Ji � MAILA��RESS /- G"PI���`/� /�-" �",i�� rt S � `�/'T �' <br />CITV ZIP PHONE <br />� IrJT[CTOROESIGNER MAILA�pPESS CITY Z�p — <br />PHONL <br />GCd�ERALWNTRqCTOR M1IqILFDDRESS �Iry <br />-" �. ZIP PHONE STATE LICENSE p -�'- <br />/ : ' /I'lOCiw .(�F,p.,��, Fo -�v � i r,eP X � ���Z�C 3 �i "� (l ////��(p}� �' I r <br />. _..� A.nCAL�NTflACTO MAILADDRE55 CITY ZIP � / ��� �Z 1 �"'-'"" 1 �a J � �.' <br />PNONE SiA�EUCENSEM <br />P,C'.'BiNGCONTRACTOF MAILADDRE55 ��ry Z�P "-- _ <br />PHpNE SiAtE I.ICENSE Y <br />�..:;: i riqc LyynGE OF 1YORK <br />.�Jtf�a,�, <br />L`E_�q IpE WORK ANO SOUARE <br />,', � a�;.yy�,.,n ,- �aL�E� %Z6� <br />����'OSEDUSE FBWL�ING <br />���i i'+ r <br />LE.,AL DESCRIPTION OF PROPERTY �SMOWN BELOW OR HTTACN TWO LOPIES) <br />LO' BLOCK OF __ <br />PMCEL TAX I.O. NUM9ER <br />CCNSTqUCT10K" NLENpER,AppqESS.TELEPHONENUf� <br />PROJECTADDRES� � <br />/ b � ��-c�� <br />KITCHEN SINK & DISP <br />DISHWqSHER <br />LAUNDRY TFiAV <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR. ETC l <br />FOR OFFICE USE ONLY: <br />�iiJNTSETBdCi'. REAHSETE <br />� / <br />❑SEZONE �L1OL4REA <br />/ � / " <br />rvrE oroor�5t No. oF Src <br />�-� <br />s¢EO'-BIDG. FIqESPRINI <br />� X�5 �� I <br />UCCUPANCY LOAD f rtiE ALARM <br />INiANE BY I NLANS <br />onr � <br />SUB TOTAL �y <br />FERMIT $ <br />TOTAL FEE S <br />/ <br />/ <br />0 <br />i HEREBY Cc'RTIFY THAT I HAVE AEAD AND EXAMINED TFIIS <br />APPLICATION AND KNOW THF SANE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNWG THIS Tir� UF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIEG HEREIN CH <br />NOT. THE GRANTWG OF A PERMIT DOES NOT PqESUME TO Gi:'E <br />AUTHORITY TO VIOLATE OR CANCEL THE PflOVISIONS OF ,�r:r <br />OTHER STATE OR LOCAL LAW REGULA7ING CONSTRUCTION OR fHE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TH[ <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR VJHICH <br />APPLICATION IS MADE AND I COt�1PLY WI7H THE STl�TG <br />CO�JTRqCTOqS LAW 1827 RCW AND 296.200 WAC. <br />G �� � � ��-%�i <br />S.Gbe LiL '�-- __ __ <br />oA<< <br />LiIY BUS�,HF 55 CCLLSE ' - <br />MECr1ANICAL <br />��� I TYPE OF EOUIPMENT FEE <br />FORCED AIR SYSTEMS-B.T.U. M E.A. � <br />UNITHEATERS-B.T.U. M ---- <br />CLOTHES DRVERS - - <br />VENTILATION FAN - - <br />RANGE FIOOD — �- <br />WATER HEATER - <br />WOODSTOVE � -- <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT — -- <br />-IEAT PUMP � - <br />3AS PIPMG -� <br />:XHAUSTFAN - - <br />SUB TOTAL S <br />PERM�T $ <br />TOTALFEE S <br />Zic� U3L <br />NpMBER PEE RECEIPf^NO',. <br />� � [� J ��' � �W�� <br />❑ YES ❑ NO <br />oui�riNc <br />acwaxcr r,oaoxxm;cuxi�; <br />� ,aa v ' PLU�dBING <br />PEO'D BASEMENT MECHANICAL <br />u YES �,X NO _ <br />HEIGiTunvTniloN ADDITIONALPLANCHECK <br />n� / _ <br />i.�C,J OTHER <br />STATE 9UILDING SURCHAFiGE <br />BY CITY OF EVERETT PU�LIC WORKS <br />LOCAL SALES <br />/.� TAX CODE IS 3105 Tora� <br />, <br />,.� r� <br />� � ��` <br />`_ <br />