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� <br /> APPLICATIO. : FOEi CONSTRUCT,' >N PERMIT � <br /> TO BE COMPLE?ED IN BLACK INK—PLEASE PRINT <br /> � r ay �HEATIN a SYSTEM: U GAS IJ ELECTRIC ❑ --- <br /> C+f [9+7 BUILDING DEPARTMENT <br /> �D �l x 259-881G <br /> � H t~i� [l DEMOLITION i � COMBINATION !✓BUILDING MECHANICAL PLUMBING SIGN <br /> rdmLnoonEss c�tr iie PHONe <br /> K o Sm .Sles �13�-(0��m�nt IJr. Fi.e�e1.+ qs�3 �2S:L-9fo/3 <br /> H�.SI IENANi M4ILADDRE55 CITV ZIP VHON[ <br /> � �"1� <br /> y ~ ARCIIR[C10RDCSiGNER MHIL.1DOfiE55 CIIV IIP PHONE <br /> � o <br /> z <br /> F] rJ GEN[RALCONiRACTOR A�AiLA00RE5S CIT� ZIP PMONF SiREUC[tISE/ <br /> 7°0 0 �J-[y _�24_ 'i�+�. i��l�-(d���_—Lst� Sf��ros 33Y-9�L'Z fJo�th4�` �ZY�o <br /> �"� � �+ ECHANiCALCONiRACTOF M1IARA��RE55 CiiY ZIP PNONE STATEIIC� <br /> �Y (] <br /> � y� 1'WMOiNGCONTRACTOA N4RAODPE55 CITV ZIP PNONE STATEUCCNS[v <br /> N F? <br /> ��/1 CONTR�CTPPIf,EOPN'ORN <br /> C] rJ VJ �� �Oo� <br /> DESCRIBE WORR!ND SOUr1RF FO'JTAGE RIVOLV6D CONTACi PERSON�ND PNONE NO <br /> �y � €,�o���ra�.._���PQ~tr�s��1 � ��.��, �_ i� 2>sa 9�13Ctb_�� <br /> H o v� ��n..�� d a�l,.rssit�ozzs�zl�oj- Zs�1 - 87eD�.Guo•k� <br /> S��r}- I HEREBV CERTIFV THAT I HAVE '7EAD AND EXAMIN[D THIS <br /> Pr+ocoseouseoFew�owc APPLICATION AND KNOW THE SF!.�F i0 BE 7RUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> i�;cn e.s,cAi�ar NOFPROPERTYIS��OWNOEIOWCRALiACNiWOWPiES� NOT. THELGRANTOING OF A ERMITJDOES NOT PR�ESUMEETO GNE <br /> ip1�`- t-- B�ocK-- oF -��'^t AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> Ppr_k-�A-- 1�11�" PEFFORMANCE OF CONSTRUCTION.THA7�qM AU7HORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FCfI WHICH <br /> $'SSb ^C'+QO_���j=OS7��— APPUCATION IS MADE AND I COIdPLY WITH THE STATE <br /> rnncE�rnx i o Hur.iuera CONTRACTORS LAW 1827 RCW AND 296.200 W�C. <br /> CONSTRIlC110NlOANlENOER.AODRESS.TELCENONE��U61fIEP y� (� /� �Z ,_ _ <br /> X �C' .i 1 .L11(a� .'a�i S — <br /> o�*c <br /> PROJECT ADORESS �'� <br /> ��� `I32� � mo�i— �iv� ���.��:�:,>s��.��.:���,. <br /> PLUMBING MECHANICNL <br /> I�' Np, TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILE I �__ A�C-A,HNDLG UNITS-H.P. <br /> ' ' BATHTUB ' FORCED AIR SVSTEAIS-B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) <br /> -T— UNIT IiEATERS-��.T.0 M <br /> 1�' SIiOWER _ CIOTHESORYERS <br /> KITCHEN SINK 8 DISP __ VENTILATION FAN <br /> 1 DISHWASHER _ RANGE HOOD <br /> ' LAUPlORYTRAY WATER HEATER _ <br /> CLOTHES VJASHER WOOD STOVE <br /> �' URINA� METAL FIREPLACE 1WOOD BURNING) <br /> ORINKI�G FOUNTAM FIREPLACE WSERT <br /> �' — _ HEAT PUMF <br /> FLOOR DfiAIN <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> '=1ROOF ORAINS-RAINLEA���RS _ _ ERHAUST FAN _ <br /> � SINK(SERVICE-BAR.ETC j <br /> � <br /> '� — <br /> I ' —_ <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> r�nu r.� r,cceirr r�o <br /> �4pNT5[iOACH <br /> �rnnseioncn sioesEtoncK �ct: +��-' ro: <br /> ��� ' �/ I_ � �, v. I . _ <br /> i�,�z���� ior naen vncnNrsire FEES VALUA710N FEE <br /> G YES F�r NO oUi��wG _ �p�_ ��' <br /> IVPEOlLOK9. NO.OFSTOPIES atcuvtxtv x00�Cxiu�recu•.�t� <br /> �aOtlP PLUMUING <br /> �SiZE7OFOIDG. FIRESPRiNNIERSREOD BASEAIEtIT <br /> �� h1ECHANICAL <br /> r�d IST� ❑ YES . � N� - _ <br /> OCCUPANCYLOFO <br /> FIRE/LARM BEO'D NEIGHT IIMITAiION ADDITIONPL PLAN CHECK <br /> OTHER <br /> -- � — i <br /> ��E�S�N �'�5 G <br /> STATE BUILDING SURCHARGE <br /> �r�inKe i3v r�nr�s avraovco Av CITY OF EVERETT PU�LIC WORKS <br /> LOCALSALES n <br /> pp,� 3 TAX COOE IS 3105 TOT^� 7 �r� <br />