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APPLICATIC f FOR CONSTRUCT� �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PflINT <br />BUILDING DEPARTMENT L HEATING SYSTEM: i;j GAS U ELECTRIC J � <br />259-8810 <br />DEMOLITION I I COMBINATION BUILDING I i MECHANICAL „9(PLUMBING i; SIGN <br />o.�v�rv+ER 1 I.1nILnCon[SC <br />/ A�L.. �I _ . CITY tiY PHO!�C — <br />iGNANi IAILFDORE55 GiY 2�P — <br />PHONE <br />AnCH1�EUOR�ESiGNER IIpILA�ORESS f.ITY ZIP PHONE <br />GCNER4LCONiRACiOR h1AILADDRE55 CITV ZIP PlIONE <br />STATE LICENSE r <br />�dECHAMCRLCONTRACTOP MAILAD�R°SS QTV 21P PNGNE <br />STAtE LICENSE a <br />CONTRqGTOR MAIL <br />PRIGE OF WORK <br />OPSCqISE WOqK AN� SOUAPE FOOIDGE INVCLVED <br />CIiY TIP PHOI�E STAi[LICENSEv <br />�..5'�.` v ti.o��4�� 6G� F�z� k" GJrI ����.�Z�� <br />�1'�° F�GI'tJ`f <br />CONTACI PEPSON ANp PHONE NO. <br />L,) e'J /' i r�-� !m v G��� 2� <br />PiiOPOSED USF. OF BWLDINC <br />� �.�� <br />lEi�nL DESCRIPTION OF PpOPER7Y �SHOWN BELOW OR ARqCM TWO COPIES) <br />��i � BLOCH - OF <br />�'MCEL TA%10. NU6!DER <br />CONSiRUCT10N LOAN IENDER. R��RE55. TELEPHONE NUA70ER <br />PROJECTADDRESS� �/d <br />/�h,�'��Co' %�� <br />pLUMBING ' <br />NO. TYPE OF FU(TURE OR ITEM FEE <br />7 WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHE3 WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE-BAR, ETC.1 � <br />SUO TOTAL S /„? : <br />_ _ ,_ PERh11T q �J� <br />� <br />TOTAL FEE $ � 3 ! <br />FOR OFFICE USE ONLY: <br />FNONTSE70ACK qEpq; <br />USEZONE <br />NPf OF CONSi. <br />52EOFBLOG. <br />occuvnNcr�oao <br />REASON <br />INiAKE UY <br />NO OF STORIES <br />FIRE SPRINKLERS REO'D <br />-IRE AIARI,I qEOD <br />PLAI�S AVPqOV[D [3V <br />DF": <br />510'e <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLI:;ATION AND KNOW THE SAME TO BE TRGE AND CORRECi ALL <br />PROVISIONS OF LAWS AND OR[11N�NCES GOVERNING THIS TVPE OF <br />WOFK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />JTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTIU?! l'R THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM 4UTHORIZEO UY THE <br />OINNER OF THIS PROPERTY TO PERFORM THE WGRK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THF. STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X,., ���/ `.�'� �_� _ �� ?--G %`y a <br />�__ A1E 1 <br />MECHANICAL � <br />N0. TYPE OF EOUINMENT FEE <br />A�C—e�unini r i murc_u o � � — <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANG[ HOOD —'� <br />WAT[R HEATER <br />WOODSTOVE � <br />METAL FIREPLACE (WOOD BUFNING) <br />FIREPLACEINSERT <br />.iAS PIPING <br />EXHAUSTFAN <br />� �U � � <br />VAGANT SITE FEES <br />G YES ❑ NO <br />BUIIDING <br />OCCUPiryCv HO WCN'FLLi4GWii15 _ <br />r,r.o.r <br />PWMBWG <br />OnSEMENT MECHANICAL <br />�.�� YES i 1 NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE �UIL�ING SURCHARGE <br />CITY OF EVERETT Puo� ic woaKs <br />LOCAL SALES <br />TA)( CODE IS 3105 rora� <br />SUBTOTAL 5 � <br />PERMIT $ ; <br />TOTAL FEE 5 —� <br />FEE � li[CEIPt NO <br />0 <br />