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APPLICAT�C 1 FOR CONSTaUCT �N PERNiiT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br /> BUILDING DEPARTMENT I HEATING SYSTEM: �j GAS �J ELECTRIC J � <br /> '_59-8d10 <br /> DEMOLITION COMEINATION XDUILDING MFCHANICAL PLUMBI�G SIGN <br /> owNFn �rar_r.ocn[sv <br /> �T7 cirv zia rr��r.= <br /> �S�gE�r ��i�✓ 7/06 �U,�iiPE2 �,� �dE,YErr (� <br /> �<<'���� MAIIApGRESS <br /> CRY dv PHONE -- <br /> nr,q�nlCiOqOESIGNEl1 IAAILpDDRE55 CITY ZIP eNONE —� <br /> yG-BlER6LCONi q[;TOR IdAIL0.DDPE5S CIiV ZIP PHONE SiATELICENS[I <br /> f�'T �.�i:ST o2/�eS 1��7�F G�1 EO/l7D.uDs �,PO�o 77r96�TC'o.fi�:�-/37��C. <br /> I.�F.CHANICALCUNTt1qCTOR 'AAtLApDRE55 CITY ZIP PNONE `TAICL�CE1lSEv <br /> PLOMBWGCONTRACTOR MAILAOOqE55 Q7Y 21P PHONE STFTELICENSFa <br /> YTRq�i PRICE 0�LYORN <br /> / 000 <br /> ❑ES/Cj�ilBti WOPK AN�SCUAFE F�GE INVOLVED CONTAC PERSON AN�PHONE N�p/J <br /> (�n��S/1Y�('T Y!/lAS�-QO ��5 llFfji�FieS <br /> �s�v ,� ,� s- ���� - <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIL9ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND nR�INANCES GOVERNIN.r'i THIS TYPE OF <br /> �ecn�nesc�a�ia/noNocar�oPearvisr+owNeeiowoanrrneHrv�oeor�es WORK WILL BE COMPLFTED WITH WHETHER SPECIFIED HEREIN OR <br /> ior-!_�_ a�p�K GOO oF �#,�J£�._� NOT THE GRANTING OF A PERMIT DOES NOT' PRESUME TO GWE <br /> AUTHORITV TO VIOLATE OR CANCtL TNE PROVISIONS OF ANV <br /> _ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCEIiq%ID.NU1d0ER — APPLICATION IS MADE AND I COMPLY WIiH THE STAT� <br /> � - - ZZ - dOO � CONTRACTORS LAW 18.27 RCW AND 296.200 WAC <br /> GG49NUC1i0N IOIH LCNpER,ADOR[55.TF.LEPHOII[NUM'nEH ) <br /> PROJECT ADDRESS - - - ��'���=��'=''=.-_ <br /> , „>:�_y-ic=y�a <br /> 7/0(0 �li�d.11l-iz /liuE �,�.�,..,..,.,.,..�..��.�.,�,,� <br /> PLtlMBING M17ECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A C-A�HNDLG UNITS-HP ' <br /> BATH7UB FORCEDAIRSVSTEMS-B.T.U. M LA. . <br /> __ LAVATORY(WASH BASIN) _ UNIT HEATERS-H.T.LL h1 <br /> SHOWER ClO7HES URYERS -�- <br /> KITCHEN SINK 8 DISP - ' VENTILATION FAN � -- <br /> DiSHWASHER RANGE HOOD - <br /> _ LAUNDRV TRAY ":ATER HEATER - <br /> _ CLOTHES WASHER WOODSTOVE - <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLAC=INSERT <br /> _ FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> __ ROOF DRAINS-7AINLEADERS EXHAUST FAN -�� <br /> SINK(SERVICE-BAq,ETC.) '- ---�-- <br /> --T- <br /> _ SUBTOTAL 5 SUBTOTAL S <br /> _ __ PERMIT S PERMIT 5 <br /> TOTAI FEE 5 TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: �` 7.SS /^ 1_!/'�r'f", <br /> ���onrsEroncn nennse�onr_H siors[mncn o�nncH-cKHura rn �ee/ , qeceir No <br /> ��- 2� z° �-+�` ��0�3 � �`; �a��-,- <br /> zaie iornn�a vncnr�tsire - <br /> � FEE:i VAWATICN FEE <br /> �_� //� z3 ❑ YES �0 BUILDING p <br /> ..LCH;I No o�Sio�iiES activRvc, � �e.�nr•� --- �V�� <br /> J <br /> �{ r.uu�v <br /> y.'� � __N� �� � PLUMBING <br /> �.:[GF 9LDG FiR[SPRINNL.tRS FEOD DASEMENi -- <br /> S5G St MECHANICAL <br /> i.i .w.n Mp -i YES �M1'N - _ <br /> ..C(,ll'ANCY�pqp FlR[Q/RMREOD H/EIGHiLItNT4ilON ADDITIONALPLANCHECK �� <br /> _ �.1r7 /fPL` aj'Z��:n OTHER _— <br /> n.:IrtSpN ,�--'- � <br /> X.-i�YC _- __ <br /> S7ATE BUILDINQ SURCHARGE � � .�?1 <br /> "J�AKEBY a�arvsarPaoveoav � CITY OF EVERETT PUBLIC WORKS � <br /> J I`� � � LOCAL SALES � <br /> n�,= cf�3J�y 1 I TAX COOE IS 3105 TaTA� ) ��, �, — <br /> - =— .� <br /> — . <br />