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APPLICATIC�I FOR CONSTRUCT' )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS J ELECTRIC ,Y/�C� ,..p�(� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION ' COMBINATION BUII.DING MECHANICAL pLUMBING i i SIGN <br /> OWNER MFILADORESS CITY ZIP PMONE <br /> S�v_7l'�_�;� �T�- �,�.o% /�93r- �a�f�R�1l <br /> �GNANT I.INIA RESS QiY ZIP PHONE <br /> AHCIIiIEGTORDESIGNER IAAIL�ODRESS dTY ZIP PMDNE W�/ l(/BD <br /> w� � �'/��,�l0o���4i�F�.�k�k�. �-�i�_-.�,,c. 9�'ya-. .-Z9D�ui'= 72�� <br /> f.[NER NTR4CTOP MNL A��RESS� CIT� IA �HO E STATE LICCNSE� <br /> MECHANICAL CONTRACTOR M�IL ADDPE55 GTY lIP PMONE STFTE LICENSE� <br /> PLUM�INGCONTRACTOR MNLA�ORESS GITV 21P PNONE STAiELIGENSE� <br /> CONTR�C7 P GE OF WORN <br /> �0 <br /> DESCRIBE WOFN FND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PMONE NO. '���,� / <br /> .Q,FHn'� tk,fr;�,•�c`�--� „ d � Sl t✓ln.�,e <br /> S . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USEO UILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROPERTV�SHOWNBELOWORAiTACHT\YOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOl" PRESUME TO GIVE <br /> �at o�acK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHE(i STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF �HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEL TA%ID NUAIBE❑ CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LO�N LENDER.ADDRE55.TELEPHONE NOMBER <br /> Y 0 n �an� 6-,�- � ,,�_ <br /> PROJECT ADDRESS sc �n neic <br /> 4.�s�s�'J'f`�D_77� <br /> ��,.a�����ss����M1.E�o <br /> PLU4BING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � ArC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATIO�FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER ' <br /> � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BUANING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � — <br /> � <br /> � <br /> --� <br /> SUBTOTAL 5 SU9TOTAL $ _ <br /> PERMIT 5 � PERMIT $ <br /> TOTAL FEE 5 TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETOaCK REAFSETBAGK SI�ESEiB4CK PL�NCH[GKNUlAB[F� FE[ RECFIPTNO. <br /> ��J <br /> usezoNe iorneen VAG�NTSRE FEES VALUATION FEE <br /> �' YES � �. NO BWLDING ' � <br /> iVPEOFCON57 NOOFSTORIES u;.c�+'.cr non�cwnu46u'ers � <br /> "''" PLUMBING i <br /> SIZEOFBLDG FlRESPRMKLERSREO'D B�SEMENT MECHANICAL <br /> ves No � <br /> OCCUCANLY LOno PIRE nlnRhl REo� NEIGIIT LVAITATION ADDITIONAL PLAN CHECK <br /> OTHER <br /> RE450N � <br /> STATE BUILOING SURCHARGE � <br /> INtANE OV PLANS�PPROV[0 BY CITY OF EVERETT PUBLIC WORHS <br /> LOCAL SALES �— <br /> o�,� TAX CODE IS 3105 TOTAL '�a ; �> <br />