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APPLICATIC'1 FOR CONSTRIJCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDRJG DEPARTMENT HEATING SYSTEM: U GAS J ELECTRIC J �J�„�✓G � <br /> 259-8810 <br /> DEMOLITION ' • COMBINATION �BUILDING MECHANICAL PLUMBING ;_' SIGN <br /> 01YNER MFILqppPE55 GTY ZiP PNJNE /�( <br /> G�,�v G��3s.e� �izy /jva�� �✓�.rt•r '1B�d.�o azy4/- 'z; z <br /> T������T IAAI�pODRE55 CiiV ZIP PHONE <br /> N�A <br /> fqCHRECi ESiGNE MAIL40DRES5 QTY ZIF PHONE I <br /> C�� �. !l,e.-r �i�.+- � I <br /> GENE4i.L GONTRnCTOR IAAII pDOPESS diY ZIP PHONE STAi[LICENSE a � <br /> �V L�i�/.� A1��� i <br /> IdCGNAMCALLONTfi�CTOii IAAiLqOpPE55 GITY ZIP PHfNE SiATEUCENSEa <br /> ���v <br /> PWMCINGCONTRPCTOR ldAILADDRE55 GITY ZIP PHOtlE STATEUCENSEb <br /> � <br /> `'✓��V <br /> CONTFRCT PRICE OP VIORH �(� v v <br /> � <br /> DESCRIPE 1VORrc AND SOUAiiE FOOtAGE R1VOW F.D CONiAGT PERSON AND PMONE N0. <br /> G��,�s /�D.OiTi,��J s�� s F� ��z� G; �� T ye,-6z�,, - <br /> �'SJQ��^'� �^�T '�rLC.S -� H�a7 i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> nForaseo use oF euaoiw APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi ALL <br /> ��_iq -,c� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> �ecn�oeswiauoNOFraoaearr�sNowr+ee�ownanrTncHrwocoaiesi �, WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> i.or���Ibf 11 e�ocrc 2 Z� oc �%Jelt-1 Y D�J , j` NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> _ �� \✓,M� 7 U{ ��n��S PqG,,; OTHER STATE OR LOCAL LAW REGCLATING CONSTRJCTION OR THE <br /> J ^ 3' PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> .SV o I-+��3' I— C�� OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEI TA%I D N11616Eti CONTflACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION L04N LENDER.ADORE55,TELEPHONE NUMO[R /_ //��/^ � <br /> �..� b �---��4�` <br /> PROJECTADDRESS ` son++onc' ) n>tc <br /> 1 l 2�i �/�/��.0 J � U✓P/CT� cu�nuvNrss��cr.,i .,, <br /> PLUMB'NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPF OF EOUIPMENT FEE <br /> WATER CLOSET(TOI�ET) A�C—AiHNDLG UNITS—H.P. <br /> BATHTUR FORCED AIR SYST[MS—B.T.U. M E.A. <br /> LAVAT03Y(WASH BASIN) UNIT HEATERS—B.LU. M <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WODD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETG) <br /> — i <br /> SUB TOTAL S SUB TOTAI 5 <br /> PERMIT S PERMIT $ <br />� TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br />, . � FFONTSETBAGKO , RE�RSGTOAC; SIDESE1aC�O PLANGHF.CKNU1.�'E� FE[ �� Af���� <br /> Z !J✓ S 3' 0 `/ <br /> usEzo �ornRen vacnNrsrte / FEES VALUATION FFE <br />, ��Z �� '. ': YES (. NO pUiLDING _ Q� /G� <br /> 7VCEOiCON$1 NOAFSTORIES ocC�i�uv:r r,oc/0.uwtr.i.';-� s� �� <br /> � <br /> �''`� PLUtd81NG ' <br /> _.���/ �'�-1 � _ —±— I <br /> SIZEOP�I�G. FIPESPRINKLERSREO'� �ASEMENT MECHANICAL <br /> SSD S • p YES � '— <br /> OGCUPMlGYIOAD FlREAL�RMR[OD HEIGNTLIMRAiION <br /> ADDITIONAL PLAN CHECK _ !�' ��� <br /> i — <br /> N A NJ '�- z� onier� � <br /> R[�SON �— <br /> STATE BUILDING SURCHqqGE <br /> n�rnKe�av ri m�s nrr aoven ov—� CITY OF EVERETT PUBLIC WORKS � <br /> ��� LOCAL SALES ' � <br /> o��c 3 TAX CODE IS 3105 TOTAL / �' �sJ' <br />