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i <br />; <br /> APPLICATIC"`1 FOR CONSTRUC7�"�N PERMIT �� <br /> � TO 8E COMPLETED IN BLACK INK—PLEASE PRINT � <br /> r i <br /> NEATING SYSTEM: �..1 GAS �ELECTR�C [.1 <br /> �n� BUILDING DEPARTMENT <br />! 259-8810 <br />' C � • UEMOLITION_ COIdBINaTION k BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAR.AJDa,55 CrtY ZiP PMONE <br /> �+-]� -�i _�D�'l�l �hP� �_�S 7_I' 7_ �_1-�ritrY� F�cFY�{-ti 9Fi�.i` I ;�,`� 1=,1 � <br /> � � iENANT �AqILpODHESS C�iY ZIP PMONE <br /> ��'Q PRCNiTEL10FDE51GNER IAAIIRDDPE55 GTV ZIP PHONE <br /> i � <br /> ��'� �Ir"ir_�ti (r�� C�c�P �, /rl � , , ., i �r �v,��c-f �j9�nl �-`>i-l �ii <br /> �' G[NERALCONTRPCiOR - MGkApDRE55 CITV ZIP PHJNc STATE��CENSE• <br /> �,�, C p�aC F[L.S C,�:•FrJ <br /> O�� C�[CNANICnLMNiRACTOR MA�LADORE55 CITY 2iP PNONE STRTELICENSE• <br /> �� PLUAIBINGCONTRACTOR MAiLADDRESS Gltt ZIP PNONE SiAtEUCEM1SE♦ <br /> ��� <br /> y CLASSOFWORK <br /> �y y � NEW � � ADDITION . ALTERATION . '� REPAIR_DBMOLITION � WOODSTOVE/FRPL INSERT � ' BUILDING RELOCATION <br /> �� p I CO4T�CL PERSON AND PHONE NO. <br /> � CONTRACi PRICE OF WORK /Z Z J �/ <br /> OESC�N��iBE\VORK RND SOUARE FOOTAGE INVOLVED <br /> �tn �i u'a �.-�1 �-�{'ac�P <br /> �—� -- vnonroseouse�ew�o�vc` i HERE6V CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> L�� �I b�l.C�('.� APPLICATIUN AND KNOW THE SAIdE TO BE TRUE AIJD CORRECT.ALL <br /> IEGAL0E5GRIPtIONOGPR01'�HtVISMOWN�EL0IVOP�TTRGNFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHI�TYpEOF <br /> WORK WILL 7E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot � —I eiocrc ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Ln1-Ll .NY1 ��t)I7'� I�`�J r�" b �7 ,� OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFO'ibl",NCE OF CONSTRUCTIUN.THAT I AM AUTHORIZED AY THE <br /> ��� ��r` Y",; � �)��1 ��� � _ 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 RGW AND 296200 WAC. <br /> � —�_. <br /> a Ii Z s .C=�raati�f r-uc-�F �i �.�n . , . zc� x �('�Ic, -f=(�15,��-- Il �iz�`� <br /> PRQIECtADpPE55 I perumne w�[ � <br /> nn eus�vrss i�c[vcc mo <br /> '�, PLUMBING MECHANICAL i <br /> NO. TYPE OF FIXTUFE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE ! <br /> 1 ' WATER CLOSET(TOILET) A�C—AMNDLG UNITS—H.P. I <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> '�' LAVATOFY(WASH BASW) UNIT HEATERS—B.T.U. M � i <br /> �— <br /> 1_' _ SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VE�lTiLAT10N FAN ; <br /> DISHWASHER RANGE HOOD <br /> 1 LAUNDRY TRAY WATER HEATER <br /> ' CLOTHES WA�HER _ WOOD STOVE � <br /> URINAI METAL FIREPLACE 8 CHIMNEY y_ <br /> ORINKING FOUNTAIN FIRCPLACE INSERT � � <br /> ' FLOOF�RAIN --� �i <br /> HEAT PUMP <br /> ' BACKFLOW PREVENTERS ; GAS PIPING I � <br /> ROOF DRAINS—RAINLEADERS —T— EXHAUST FAN <br /> �� _ SINK(SERVICE—BAR,ETC.) <br /> 1' 1 I <br /> � � <br /> —�— <br /> 1 SUSTOTAL $ SUBTOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> �' TOT�L FEE 5 TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: ' <br /> i <br /> FqONT5ET0ACK �EARSETDA K Si�ESETB�CN PL�NC��[CHNUMBER F[E . ! FECEIPTNO I <br /> ,�� p� �ra" �,�rnc� � � 3 .(��" -s �"=' 7y5�3� <br /> usezone�7 io*nnen VALANT�j FEES VALUATION FEE 'I <br /> � "{--- �� �UILDING ,�/�/// ;(>(� , <br /> iviEOfCONiS.RLl01VRBLE IYPCOlLONSt.ACipAI occuvsvcr na o�axnuvcow�s ��� i <br /> _ J LPq1P PLUM9ING � <br /> S2EOF�LDG NO OFSTORI[5 BASEMENi MECHANICAL 1 <br /> O�PANC,Y\0 D flPE SPRNKLERS REO'0 NEIGNT LIMITATION ADDITIONAL PLAi!CHECK <br /> ��/H' I �J/A I SPRINKLFR ' <br /> NEASON FOP$PRINNlERS <br /> STA?E BUILDING SURCHARGE ��i� <br /> �r,r�Ke ov PlANSAPPROVEDOV CITY OF EVERETT PUOLIC WORNS <br /> ' I� LOCAL SALES � ;� <br /> A7 2 1 i L TAR CODE IS 3105 TO7AL <br />