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APPLICATIC'1 FOR CONSTRUCT" �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT _ HEATING SYSTEM: �GAS ❑ELECTRIC J <br /> 259-8810 <br /> DEMOLITION COMBINATION ,7( BUILDING MECHANICAL 1 pLUMBING ; ; SIGN <br /> OWNER • IAAILADOqE55 CITY <br /> �!2� �r�slc� 113 c M�J1�V� C�l�zerr �Z82s�g 3�Eg�zg. <br /> iLNNJT IdAILADDPESS CITY IIP PHONE <br /> nRCHiiECTOPD"e51GNER MAtLAD�RE55 CIiV ZIP PHONE <br /> GENERdL CONTFACiOR M�IL ADDFESS dTY ZIP PHONE STATE UCENSE v <br /> ��� r- <br /> 1dEGHANICAL CONTRACTpq pIAIL ADDRE55 CITY ZIP PHONE STATE UCENSE r <br /> PLUM9INGCONTPACTOR l.IqILqDDRESS CITY ZIP PMONE STATEUCENSE/ <br /> �NTRACT PRICE OF\YORK <br /> (IU <br /> DESCRIEE IYOPK AND SOUARE FOOTAGE INVOWED CONTALT PERSON AND PNONE NO <br /> Co s72��r s i��I F �aw��ly � � rJ <br /> Or �L i HERE6Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaoaoseouseoFem�oi�N/c���� � ' I. . �� � �� �� � qppUCATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> � � ' —!`�� �u SI�SL�JJ� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOE$CRIPTIONOFPROPERiV�SNOWt�ee�owqU[+nrTnc�rn�mcoaies WORK WILL BE COkPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �QT �P — oiaK� oF ` �(}'�' (�r NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> y� 1 AUTHORITY TO VIOLATE OR CANCEL TF;E PROVISIONS OF A�JY <br /> ��T�-L�_��JJ✓�1�1 d ��Ilrj(��_f OTHER STATE OR LOCAI LAW REGULATING CONSiRUCTION OR THE <br /> PCRFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TIiE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> aFace�T noNur.+eE� APP ICATION y� MADE AND I COMPLY WITH THE STATE <br /> O CONT A S/�A r CW AND 296200 WAC. <br /> CONSTFUC ION IO�N IENDER.�D�NESS TELEP+IONE NUMBER <br /> -i' J/�ll �`�! -�i 1 <br /> P�70JECT ADDRES � '� ����� ti�;,. , e o��� <br /> �� CI�-Gl cnvousrritssucn�sr_mo <br /> PLUMB G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> �3 WATER CLOSET(TOILET) � AiC—A�HNDLG UNITS—H.P. <br /> I BATHTUB � � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV�WASH BASIN) �� � UNIT HEATERS—B.T.U. M <br /> Z SHOWER I CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; � VENTILATION FAN � <br /> 1 DISHWASNER ( RANGE HOOD <br /> � LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER � WOOD STOVC: <br /> URINAL METAI FIR[PLACE(WOOD BURNING) �-- <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT <br /> �LOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS ExH�1U5T FAN <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br /> � <br /> � <br /> SUB TOTAL S ' SUB TOiAL $ <br /> _ PERMIT $ � pERMIT S <br /> _ TOTAL FEE S ' TOTAL FEE S �— <br /> FOR OFFICE USE ONLY: 9� �� <br /> LNOHTSETA4CK RE�RSETBACK SIDESETBrGK PLANCHECHNUM�[R FEE REGEIPTI�O. <br /> '�' zp' S �-I y 5 � 05�I I <br /> usez°g�p� �ornr�ea �S�/ vncnNrsite FEES VALUATION FEE <br /> {��` �pO Y' �.� YES �' NO BWLDING I�3 Z.OZ _, � � i—� <br /> tvPCOFG01lSi NOAFSiORIES pc[enR•;cr x00rOwFum'GuunS —y � <br /> --/J L c��,�,�c 1 PLUM�ING I i ��.) <br /> SIZE�F�LD FlRESPRINKLERSRW'D BA.EMENT I�D i LO <br /> ZY IS �.F 'F _ MECHANICAL , <br /> sz6 s �aaA - � ves ✓o — � _ <br /> OCCUPnNCvlOAD FIREALnRMREOD NBGHTLIldliAilON ADDITIONALPLANCHECK �(/ i/� <br /> � UU' <br /> N A N� � OTHER ; <br /> n[nsor+ —_ _ �� �0:. <br /> STATE�UILOING SURGMARGE / � . -� � i <br /> u�inHc ov ri nNsnPvnoveo ov CITY OF EVERETT puouc wo9Ks , v ; <br /> LOCAL SALES <br /> on,e � TAX CODE IS 3105 Torn� ' <br /> �v Z3/5 � 073 � /-L <br />