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APPLICATI�1 FOR CONSTRUC� �ON PERMIT <br /> TO BE�OMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTM�NT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> J259-8810 <br /> {t� DEMOLITION ❑ COMHINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> o�p AGI� }IAit.DwlhtE �ISZ'i 39�� �j� u- Ot.c� R8'2oy P� <br /> TENANT MA�LMORESS CIiY ZR Pi1pNE <br /> �RGHRECTORDESqNER W0.ADDRE55 CITY ZIP PMONE <br /> � ' 6ENEfUL CONTRACiOR AAI1R ADORESS CITY 2IP P1qNE STATE LICENSE� <br /> Sf qzl�l�' �py�'�. CO. ' <br /> MEClMNICKCONiR/�C7pq W0.110DRE55 CIiV ZIP PNONE STAIELICENSEI <br /> ' ������'�T� M�ti�E55 CITY ZIP PNONE STA1E LICENSE� <br /> CONfRACT PRILE OF WOIM( <br /> DE9CHRE NORK MID SIXIARE FOOPWE MVOW'cD CONTACT PE1150N NID PIIp/E NO. <br /> �0 <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> rnoPoseouseaceutioMo APPUCATION AND KNOW 1HE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF lAWS AND ORDINANCES fiOVERNIN(i THIS TYPE OF <br /> LEd1L0E6CRIPTIONOFPROPERT'(911pMMlELpWppATT�CHTWOCOPIES) NfORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEPEIN OR <br /> iaT �� � NOT. THE 6RANTINO OF A PERMIT DOES NOT PRESUME TO dIVE <br /> — AUTHORITY TO VIOLATE OR CANCEL TME PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REOULATINfi CONSTAUCTION pq THE <br /> PERFORMANCE OF CONSTqUCT10N.THAT 1 AM AUTMpRIZED BV THE <br /> � OYVNER OF THIS PROPERTY TO PERFORM TME WORK FOR WHICM <br /> FMCELTiU(I.O.NUMlER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA TORS LAW 7827 RCW AND 2G8.200 WAC. <br /> I CONSTRUCTION LONI IENDER.l10d1EB8.lElEN1011E NUMMER <br /> • iv-�-�� <br /> � n�o.�cr aoo�ss —� �,.�.� ,,,� <br /> ; e.., a,..�..,���. <br /> � Ku�u r�a��►Mcn� <br /> N0. TYPE Of FlX NI1E OR ITEM FEE N0. T�fPE OF EOUIPMENT fEE <br /> � WATER CIOSET(TqLEn � NC—AMNOlO UNITu—H.P. , <br /> � � �THT�B ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> . LAVATORY ASH BASIN) � UNIT HEATERS--B.tU. M ; <br /> SMOWER ' CLOTHES DRYERS � <br /> � � KITCHEN SINK 6 DISP � VENTIUITION FAN � <br /> - DISHWASHER � RANCiE HOOD � <br /> , LAUNDRV TRAY ; WATER HEATER � <br /> CLOTMES WASMER � WOOpSTOVE ; <br /> URINIIL � METAL fIREPLACE(WOOD BURNINf3) � <br /> DRINKIN(i FOUNiA1N � FIREPUCE INSERT . ; <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PqEVEHTEH3 ; 6AS PIPINO � <br /> ROOF DRAINS—MINLEADER3 � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ' � <br /> � ; <br /> � , <br /> � � <br /> SUB 70TAL S ; SUB TOTAL 1 ' <br /> PERMIT S � PERMIT { � <br /> TOTAL FEE S ' TOTALFEE t ' <br /> FOR OFflCE USE ONLY: <br /> FPONTSETBACI( REARSETBIICN SIDESETBACK PUNCNECKNUMBEH FEE RECERTNO. <br /> USEIONE LOT�RE� . V�CANTSITE FEES VAlUA710N FEE <br /> O YES ❑ NO BUILDIN6 i <br /> TYPEOfCONST. NO.oFSTOi11E5 atCiro�Mtr wo.OioNFlliM6uMrt6 � <br /> 6� PLUMBING <br /> SIZE O:BL00. FlflE SPPIHKIERS REQ'D B�SEMENT MECHANICAL i <br /> ❑ YES ❑ NO <br /> OCCUP�YCYIO�D FIREIILARMREO'D NEqHTLIMITATION ADDITION�LPUNCHECK � <br /> OTHER � <br /> REA90N — <br /> STATE BUILDIN(3 SURCHARGE ; <br /> MTIU(E BY P1�N511PPROVED BY CITY OF EVERETT PUBLIC WORKS ' <br /> IOCAL 8ALE3 <br /> o�re TAX CODE 18 3105 ror�� � <br />