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� APPLICATIC"1 FOR CONSTRUCT' 1����'6 <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> _.._ <br /> FEB 1 � 199.� <br /> .......... <br /> HEATING SYSTEM: .�GA� ,J ELECTRIC J C�]'Y OF—eiT�—.� <br /> BUILDING DEPARTMENT <br /> 259-8810 P�b�j� Works pe t T <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �PLUMBINGA SIGN <br /> O =R IAaILADDRE55 CIiY ZIP PHONE � <br /> - .��/ � '�l� - �u�-1Y� <br /> TENANi , IAAIL��OFES � GiV 21P PHONE <br /> � // C� 1 / r1 �/ <br /> /t',�Af- ��0 � f�Clt' �;. '��?� <br /> �RChRECTORDE5IGNER IA41�pDDRESS G�TY ZIP PHON[ <br /> f.ENFjilLGONiRA�TOR RIAILADOPE55 GITV ZIP PHONE STATEUCENSG• <br /> p�' (d �Q7.E�[w7«u <br /> MECIIANI ALGONTRACTOR 61qILqODRE55 GTY ZIP PIIONE STATELICENSE• <br /> P ING GOMRACTOH AIL AODRESS CITY ZIP ��ct�j�� STATE UCENSE/ <br /> �����n���. 3 3 y - ° m:�• �i Pr cP� �oi �k� <br /> CONTRACT PRICE Of WORK <br /> �SCRIBE WORK A D SOUt.RE FOOTNGE I VOLV/ � CONTA P SON AND PHONE _ / �%�/ � � ^, � <br /> -6s.�.(n �nn Ka�d-�Ff - .Qtd 9' �d-t�-�C'iE� �v•r 5� v, <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aRovoseo use oF euaort+c APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPFOPERTY�SNOWNpELOWOBATT�CHTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEC HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAR e�.n>,i e.NUMo e CONTRACTORS LAW 18.27 RCW Ary'D 296200 WAC. <br /> 3 /- _ 0�3 - 000' <br /> CONSiFUCTIONIOANLENDER.ADDRE55.iELEPHONE NOI.IBER <br /> � . _ �� �-��o - �vl <br /> PROJECT ADDq S ��c��*�' ���E <br /> a �� -� <�,.��s��Es=�����_«�; <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OP EOUIPMcNT FEE <br /> _� WATER CLOSET(TOILET) p0 AiC—A�HNDLG UNITS—H.R _ <br /> �_ BATHTUB i' ; � FORCED AIR SYSTEMS—B.T.U. M EA. _ <br /> � LAVATORY(WASH BASIN) �00 UNIT HEATERS—B.T.U. M ; <br /> SHOWER CLOTHES DRVERS <br /> —,-- <br /> KITCHeN SINK 8 DISP ; VENTILATION FAIJ <br /> DISHWASHER � RANGE HOOD �- <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOV[ � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR ORAIN HEAT PUMP _ � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> —T— <br /> SUB TOTAL $ � jp(7 SUB TOTAL 5 <br /> PERMIT 5 (j � Q PERMIT S <br /> TOTAI FEE $ � � � TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONiSETDAGK RF.ARSGTBACK SIDESETBACK P.nNCNE KNUMBER FEE RECEIPTNO <br /> usezoNe LOTAREA vncnNrsire FEES VALUATION FEE <br /> �—! YES � � NO 6UILDING <br /> IVPIOfCONSt NO.OFSiORIES ecc.ra�;cr xoo�ownur,su�ns — — <br /> i <br /> "�LpP PLUMBING � <br /> --�_ <br /> SIZ[OFBLDG FIRESPFINKLEBSREO'D O�SEMENT MECHANICAL <br /> YES ❑ NO <br /> oCCUrpNcvtono FIRE�LARMqEOD Heic��run!rtnTiou ADDITIONALPLANCHECK <br /> OTHER <br /> REASON —�— <br /> STATE BUILDING SURCHARG[ <br /> INTANE BY PLANS APPROV[D�Y CITY OF EVERETT PUBLIC WORKS <br /> LOCAL SALES <br /> onT� TAX CODE IS 3105 TOTPL <br />