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H 37/ �Y <br />APPLICATI(�-' FOR CONSTRUCT[ `N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PHI�IT <br />HEATING SYSTEM� �'i'',AS J ELECTRIC _1 <br />BUILDING DEPARTMENT -- <br />259-8810 <br />DEMOLITION COMBINATION <br />r.�na aooAEss <br />�e,,- 2o�y= L <br />t�niL AO�JRE55 <br />ldAIL FpDRE55 <br />1AAIL n�ORE55 <br />1.inR qODRE55 <br />TENANi <br />AFCHITECT OR OESIGNER <br />GENERALCONTRAGTOF <br />G,ECMAIIiCRL GONTRAGTOR <br />� �Gu /�2.r <br />P W L'[3 W G GONTF�CTOR <br />� <br />PRICE OF WOPK <br />\ Q� <br />IAqIL �ODRESS <br />BUILDING MECHANICAL PLUMBING <br />UTV ZIP PHONE <br />y��, A� �r� a� �'�zo3 355-��s <br />PR,OIPOSED U�SE OF B111�01NG <br />!'7O� <br />IEGAL �ESCRIPTION OF PROPERTV �SHOWN BELOW OR ATTACH TWO COPIES� <br />�or e�xK oF <br />PqRCELTA%ID.NUM9EF <br />cor+sTivucriaN �onN �ENOEn. <br />NO. TYPE OF FIXTURE OR I' <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRI�KING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOVJPREVENTEPS <br />ROIJF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR. ETC.) <br />FOR OFFICE USE ONLY: <br />fRONT5ET84CK REARSETBACH <br />USF IDNE LOT FFFA <br />1 vVE OF GON51 <br />S12E OF BI�G. <br />OCCUPANCYLO�D <br />INTpKE 6Y <br />NUMO[R <br />GTY Z:' <br />CiTV TiP <br />GTV ZIP <br />CRV ZIP <br />CITY IIP <br />CaA 9�zQ 3 <br />SUBTOTAL $ <br />PERMIT S <br />TOTALF[E S <br />FIqE SPRINNLERS REO'0 <br />=1RE AL�RI.1 REO D <br />P�a���s nvrqc�eo cr <br />oarE <br />PHGNE <br />PHONE <br />PHONE S7ATE UCENSE v <br />PNONE STATELiGENSE+ <br />PMONE STATE LICENSE e <br />CONTACT PERSON AND PHONE NO. <br />SIGN <br />i HEREBY CERTIFV THAT I HAVE READ AND EXP.MINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETtD WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AU I MURIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC <br />x/A �AJ�.c�.. � – <br />yi�I�p1U�iC �6IE <br />GIVPUc1�ytiUO1:• r�p <br />MECHANICAL <br />VO. TYPE OF E�UIPMENT FEE <br />NC—AMNDIG UNITS—H.P. <br />FORCED AIR SVSi=MS—B.T.0 M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STO�'E <br />METAL FIHEPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />—� <br />HEAT PUMP <br />,� GAS PIPING <br />EXHAUSTFAN � <br />SIDESLTBACK PLANCHECKNIIIA�[R FLE <br />vacnrvrsrte FEES <br />� VES . NO eUILDING <br />cacdra.c. �:na:mrturisus:s � <br />c'�.� PLUMBING <br />enserAENr MECHANICAL <br />� �. YES � - NO —� <br />NEiGMTLIMiTATiON �DDITIONALPLANCHECK <br />OTHER <br />StATE BUILDING SUiCHARG[ <br />CITY OF EVERETT aueucwoaHs <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE S <br />