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APPLICATIC .� FOR CONSTRUC7 .ON PERMIT ;;�� <br /> � ,,-/v�. <br /> TO BE COMPLETED IN BIACK INK—PLEASE PRINT `�"'�� <br /> NEATING SY57EM. ' GAS J ELECT C J ____—-- _ -- � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> AIAILAD�RESS Cy�V ZIP PH04[ <br /> ���=u ui✓ki+ „ ,� � ���F��r%e r'Il� l,l/�°%f��T5�',—`�''G� S <br /> TFv�T �^/AILAODRE55 CrtV 2iP P��ONE <br /> � 7"✓' <br /> RRfN.iTECiORDESIGNFR MnRADDR[55 CITV 21P PHONE <br /> 6CM1CRAICONTRACTCR SIAILAD�RE55 <br /> GTY ZiV P��ONL StATEUCENSE• <br /> ME ALCON1RACi i RtAILAO�RF.,95 / UTY Z� �'MONE SiAiEIICENS[� <br /> / <br /> ��� � i �a `.5���� �•/����Z�'�-���1�{�ill'-`�$-'j�' <br /> p �� PIWd(3P�GLONTRAGTOR MAi AODRES ITV ZIP � PHONE TNELiCENS[a <br /> C, N <br /> � y y CLASSOf WOAK <br /> N � � NEW ADDITION � ALTERATION REPAIR DEMOLITION WOODSTOVEFRPL INSERT BUILDING RELOCATION <br /> y 7 Fi CON*�CLP[RSONANDPNOHENO <br /> O.�i O CONTiiACi PRICE OF WOFN /'� <br /> 9C�.-- - '�x��'1�' - <br /> �U M � .SCRIBC y�RN�N� AF[( 1�GEINV LVED . � Y'1�,q�� � ,L�G <br /> �z� ?E lcaa �" rr�-�.�� � ��;c � -�� �«� �� , <br /> � rnoaoseouseorouaoir,c i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> y � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ier.n�oeseaianor+oFaaovearrisr+owrvec�awonn+rncNFouHcoPicsi PROVISIONSOFLAWSANDORDINANCESGOVERNWGTHISTYPEOF <br /> '.�Hd � t7 WORK WILL BE COMPLETcD WITH WHETIi[R SPECIFIED HEREIN OH <br /> �� n �o� p�p�K or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> x y� �/��� _� � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> �y y. PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> H H OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> g� APPLICATION IS MADE AND I COI.IPLY WITH THE STATE <br /> n ty y CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> �c�r <br /> H N X , l� /�� �J' � . -7.r"�� <br /> H O!� — ....—�- ��.,:� <br /> � vnae Tnooaess �/ .•. :.. <br /> 4 � � ��'(/Al r � '� . nnt9��.,.cc.. i _ <br /> PLUMBING MECHANICAL <br /> NO. fYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � WATER CLOSET(TOILET� _ ��_HNC:G UNITS-H P. <br /> I ._� _ BATHTUB — FORCED AIR SVSTEA45-�.T.U. M E.A. <br /> ��I LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. h7 <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN . <br /> � '�� DISHINASN[R ' H�NGE HOOD <br /> I __� LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL -/ IdETAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN / FIREPLACE INSERT <br /> __ FLOOF DRAIN _ <br /> HEAT PUMP <br /> BACKFLOW PREVENTEflS ', GAS PIPING <br /> ROOFORAINS-RAINLEADERS � EXHAUSTFAN <br /> SINK�SERVICE-BAR,ETC.) <br /> !1� <br /> I _ ---� <br /> � SUBTOTAL S /�� <br /> I �1 ' SU8 TOTAL S pERM1T S <br /> � � PERMIT 5 �� <br /> `\ TOTAL FEE 5 TOTAL FEE S �U' <br /> FOR OFFICE USE ONLY: <br /> FRONTSET6AGN REARSEipACY. SiDESEtOPCH �L�YC��CGKNW.�eER FCIf AECE�PiNO <br /> J�1 I `�� <br /> 5[20NE LOTAREA VACANi51TE fEES VALUATION FE� <br /> eui�owc _ <br /> iVP[Oi CON15 AIIOWABIE IYPE Df GONSL ALiOAI cc6pomCr rva oi rfiui�r,�y;s <br /> PLUMBING <br /> SiZE OF BlIX'i. NO OF STORIES BASEMENT MECNANICAL ��,/ � <br /> OCCUPANCYLOAD FIRESPRHnLER5RE00 NEIGHiLIM11AiiON ADDITIONALPLANCHECK � <br /> � <br /> SPRINKLER <br /> —---T— <br /> R[RSON FOR SPRINNLERS <br /> SiATE DUIL�ING SURCHARGE <br /> iNrnKe ur rinHsnrrnaveo nv qTY 0F EVERETT PUBUC WORKS <br /> LOCAL SRLES <br /> TAX CODEIS 3105 TOTAL <br />