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� APPI..i�CAT10Pi F'OR CONSTRUCTION PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIN i �T� <br /> . HEATING SYSTEM: J GAS ❑ELECTRIC �J =_J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> CJ DEMOLITION !;, COMBINATION �( BUILDING [ i MECHANICAL CI PLUMBING SIGN <br /> OW�� �Y�\IMAI�T 5 I I�� � I�� Y�� PHO�T V� • �W{J_ <br /> TENANT 61ARADDPE55 CITY ZIP PHONE <br /> pRCNITECiOR ESIGNER IdAILA00RE55 C�7V ZIP PNONE <br /> GENERAL CO RACTOF MAIL ADDRE55 GITY ZIP FHONE STATE LICENSE n <br /> � <br /> MECMANIC � C�OR h1AIL FDDRESS GITV Z:P PHONE STATE LICENSE a <br /> PLOM9INGC TRALTOF MAILAO�RE55 CITV ZIP PNONE STATELiCBISE• <br /> CONTRACT ICE OF WORK � S � <br /> Wr,o� bOC. <br /> OESGRIBE WOFK AND SOUARE FOOTAGE INVOLVED WNTqCT VER50H AND PHONE N0. � <br /> � – – <br /> 3 �"�1L ?� � ?.t�' � � /+F� (,Ocu►�.rZ� <br /> CI�� `I� ��� i HEREBY CERTIFY THAT I HAVE READ �ND EXAMINED THIS <br /> rgoaoseo use uF em�owc APPLICATION AND NNOW THE SAME TO BE TRUE AND COflRECT. ALL <br /> �Yp;.�.A�f�'G �N ��S'.�T�C��. 1�SC PROVISIONS OF LAWS AND ORDINANCES G(1VERNING THIS TYPE OF <br /> �Js�-_ <br /> �ecnioescaianonoFPacaer�rv�s�N�owlNee�owon`T�c!+�coPies�S� NOT THELGRA T�ING OF A PERMITIDOES NOT PRIcSUME TO GNE <br /> �or--� BLOCK —1-�— oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Qf}��pE+ � E14ST �J, M. OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THL= <br /> �+ �y ;�,�_` OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICFi <br /> '�� ��1 VOL-1 '� APPLICATION I DE I COMPLY WITH THE STATE <br /> PARCEL iAX I.D.NUMBER CONT ACTOR W�.Z� C ND 29620P WAC. <br /> CONSTFIICTIDN LOAN LENDER.ADORE55,-E�EPHONE NN.1�ER � O�'�� <br /> �.,_ O�iCO __-- <br /> PROJECT ADDRESS ;� � sicrv_nun,_ _ <br /> cvvem�r:essucevse �o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE _ <br /> WATER CLOSET(TOILET) A/C—A'HNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> L.4VATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M �_ <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTIIATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDFiY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE , <br /> UFINAL ��:ETAL FIREPLACE(WOOD BUflNING <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOft DRAW <br /> � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> � <br /> SINK�SERVICE—BAR,ETC.) <br /> I <br /> I <br /> � <br /> I <br /> --� <br /> � <br /> SUB TOTAL 5 SUB TOTAL S <br /> PERIdIT S P[RMIT S <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: — <br /> FRONTSETBACH REAfI5ET84CK " ESETBALK PLANCHECKNUf.16ER FEf. RECEIP`HO. <br /> � !� <br /> usezor+e IOTAPEA vnc.irvisire FEES VALUATION FEE _ <br /> : �� YES �-, NO gui�oiNr SOO� ��� (_� <br /> lviceoiCONSr. No.oFST iE5 acu�nr.n uoa�oaaur.;i;:�s — -- <br /> cFouv p�UM91NG <br /> � i <br /> 512EOf�LDG. FI -SPRINHLERSREO'D BASE�dENT MECHANICAL <br /> i. YES �..� NO � ... <br /> , <br /> OGCIIMANCY IOAD FIRE AL�RM REO D NEIGHT I.IMITATION �DDiTIONAL PLAN CHECK i <br /> �( i _ <br /> OTHEF <br /> I�enSON 6 i <br /> STl.TE BUILOING SURCHARGE <br /> i��i�,Mr nv � r�nrvs nrn�oveo ov CITY OF EVERETT PUBLIC WOPKS <br /> LOCAL SALES <br /> I ���F _ TAX CODE IS 3105 TOTAL <br />