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l'l [yti � <br />AxJx <br />ayy <br />y�H <br />� H� <br />'� H'{I <br />fA H <br />� �'] d <br />Q H <br />��g <br />�] V � <br />9 H� <br />4 <br />t HH <br />8 `� <br />�d� <br />��[r�l <br />H O tNi� <br />APPLICATI�:�1 FOR CONSTRUC7�ON PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT `� <br />HEATING SYSTEM� ❑ GAS �� ELECTRIC iJ _l <br />BUILDING DEPARTMENT <br />259-6810 <br />DEMOUTION COMBINATION BUILDWG MECHANICAL PLUMBING SIGN <br />OWNER MAILAOORE55 CIiV ZiF PNONE <br />t�u�i�'r �ll�l.�ii I;� h�'K �3i',�E "T ll� ��',CY� 'SG-3/G� <br />MAILAODPESS CIiV ZIP PHON^ p ��� <br />TENANT.. � n .. . .� ✓a K_'_ t Y.� _.... f1. � nG,f7/� 4�����4V- <br />_ � <br />GE,�RALLONTRRCTOR MAILA�DRE55 CItY 2iP PHONE STAi LI N <br />CiiY 21P PMONE SLATELIC"3E� <br />inCCHANICALLONTRACTOR MRiLADDRE55 <br />C�TV ZiP PMONE STAtE LICENSE � <br />PWMBINGCONTRACTOfi N.\ILdODRE55 <br />C�nS50F WORH <br />�' NEW . ADDITION ALTERATION REPAIR DEI,IOLITION WOODSTOVEFRPL INSERT BUILDING RELOCA I <br />I CONT0.LTPEASONAty0PM0��FN0 � , , �� <br />:OMRACT PRICE OF WORN <br />JESCPiOEWORNAND50UAi1EFDOTAGE�/��jVO�YED <br />f'O ^�� :CL�.--s1�.� <br />�'ROo05E � SEOFBUILDING <br />l[GAL �ESCPIPTiOY OF PROPERiV I$HOWN BELOW OR AiTRCH FOUF <br />�pT _ 6LOGK OF <br />i?c�s ` i � . �� �� "�— — --- <br />i=no�ecrnooaess <br />NO. TYPE OF FIl <br />WATER CLOSET ITC <br />BATHTUB <br />LAVA70RVIWASHE <br />SHOWER <br />KITCHEN SINK 8 DI; <br />DISIiWA511ER <br />LAUNDRYTRAV <br />CLOTHES WASHEF <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />qPPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOPK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWFER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE ST�TE <br />CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br />. <br />' i I � � � )— <br />X-��:'^ � � �l1�'" 3 � <br />— -- �.�?�� �>,, <br />OR ITEM FEE N0. TYPE OF EOUIPMErv i <br />A C—A HNDLG UNITS—H.P <br />— — FORCED AIR SYSTEIdS—B.T.U. M E.A. <br />-- , UNIT HEATERS—B.T.U. M <br />SUB TOTAL <br />PERMIT <br />I - TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FPONTS[TOICH REARSE104LK SIOE <br />iYPfOftOtI15.ALLOWABtE 1YPEOf[ONSI.ACIOAI <br />�-N �-rU <br />SiZEOFBLDG ��y NOOFSTOPIES <br />O� ��CY LOAO FlRL SP� LERS REC <br />4� � <br />REASON FOR SPPINNL[RS <br />({2f�1NA�� <br />iNLANEBY �L�NSAPiii0vL00V <br />ir.v <br />WATER <br />WOOD <br />8 <br />PUMP _ <br />�IPING � <br />UST FAN — __. ' _ <br />NUMU[(i <br />V�CANT SR[ �c�� <br />DUILGING <br />aar rva uo m onuuxcuxns - <br />� �� r�ui.+oiNc <br />��5[MENT MECHANICAL <br />Nc` - <br />MEiGHT uMITnnON A�DITIONAL PLAN CHECK <br />SPRINHLE(i <br />STATE BUILDING SURCHARGE <br />CITY OF EVERETT FUBLIC WORNS <br />LOCAL SALES — <br />TAX COOE IS 3105 TOTAL <br />TOTAL 5 <br />v11T S <br />�l FEE S <br />�OO <br />