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I lw C. -'...I uulu 1.1 I "I a.ul, •nl, U1u�1 SLI' Im 11J711 I0:191111 Ilab•I P.U, <br />APPLICATIfo FOR CONSTRUCWN PERMIT✓ <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: I GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259 8810 <br />11 DEMOLITION • 1 1 COMBINATION I I BUILDING LI MECHANICAL I I PLUMBING <br />7rvnlin - YnIAOUIVFb - tor- nr ,-IF <br />l ?61N4YNldlNOt"OC 29/[Yr�1 +i�A� l.io 25Y'93[O <br />wAAmOtxx cnr nY vlKwe <br />7,K'H1lFCTMI fltb4'NtP AIAA Atss CITY 11r rMUNE <br />7N6CO Rrn;SVIR"ZgI Lrje._f&Q/ <br />ULNERAI CMITIIAC ION LIAR Al Cllr Ilr rMWF til All IKINVA <br />Vtv"AI11CA1 :LIIMMCIOR MAN ADOlitbb <br />HIMP%IACONIIIM.IOq YA4 AMNfbS <br />nIt ]iv <br />ply IP <br />CLMfPAG1 rn4[+OYf�W�gIiIX�/ � � <br />tlfR Alnr wOAK Pill StIlA1(C ll�i� V[D - — <br />KBlALP1eb—�1f27G_i <br />f'ntN[Rro ubC Of nunUYKI <br />�HmI nCLCIurIAIIM MG•4nrlPNMYN oIL<NIOP ntrnCH IwL1LMIr C1 <br />LOI WtK.K <br />YAXf[1 lA%IU MMFTn .-- — <br />CINIbiP11CIKW I OAH It Nni R. AWIIEbF.lflllTMB M0.gtl1 <br />LAVATOHY (WASH BASIN( <br />_ SHOWER _ .- <br />KITCHEN SINK A DISP <br />—_ � f71$HW_ASIIEn - <br />LAUNDRYTRAY _ <br />__ CI OTI ICS WASHER <br />UnINAI <br />- ORINKINLI FOUNTAIN <br />FLOUR DnAIN <br />BACKFLOW PREVCNTEHS <br />FOR OFFICE USE ONLY: <br />fPMll s'lTyb4� <br />NEAP n[-�/ <br />IDTMYIARCA <br />ITH Orfops'_ <br />in M61wms <br />:Qj <br />2 <br />__ <br />blef(✓him.. I� <br />DRf b��D ACOD <br />'M.cUI.AIICyI(iAn <br />rl&1l AMA MOD <br />_ -Ely <br />�.— <br />ufbvuNt---�-- <br />Inn%t <br />[R[IDACN <br />r11M SIAIt IGFNif I <br />PNLNF b1Mf11fYKRl <br />rMTACT rt Nb(w AND rime Nt1. --- <br />I I SIGN <br />1 rlrt iTLf�{�6�-EG-�IG6lAfIYLC!//'f•/�1It�L, <br />(7,0(a) 2z3 -l3(0IF <br />I HFRERY CERTIFY THATN HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND DRDINANCFS GOVERNING TI IIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHCTHEn SPFCIFIED HEHFIN OR <br />NOT. THE. GRANTING OF A PERMIT DOES NOT PRESUME TO GIVL <br />AUTHORITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br />OTHER STA1 E OR LOCAL LAW REGULATING CONSTRUCTION On THE <br />PERFORMANCE OF CONS FRUCTION.1 HAT I AM AUlHOF41210 BY THE <br />OWNER Or THIS PROPERTY TO PERFORM 1HF WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH 1HF STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />tllMV1l1[ _ Ilnll <br />TYPE OF EOUIPMENT <br />14c <br />-/VIINDLG UNITS-H.P. <br />CED AIR SYSTEMC-U.T.U. M E.A. <br />i. <br />"HEATERS -U.T.U_M _ <br />THES DRYERS <br />TILATION FAN <br />OF. HOOD <br />ER HEATER <br />)D STOVE <br />_ <br />AL FlREPLACE Wj o0D BURNING) <br />_ <br />:PLACE INSEFIT <br />T PUMP <br />PIPING <br />IAUST FAN <br />i <br />_ SUB TOTAL i <br />PEHMIT S <br />_ <br />TOTAI FCC T <br />i�JAMlNA <br />rFf/ /� = <br />IItCFI9I, A OCJ <br />[1 YES I I NO <br />RUILDINO 15� <br />J_ <br />2.? / 3 <br />RfYM.I MbIM111 A4VM15 <br />PLUMBING <br />DAStYRIi <br />I I YES X NO <br />ME014ANICAL <br />ADDITIDNAI PLAN CHECK <br />❑fIONILMIl1TY%1 <br />DTUIn <br />SIATE BUILINW1 SURCHARGE <br />q, <br />'/ CITY DF EVERETT <br />PUBLIC WORKS <br />