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qmft AN, <br />- FHUM:CITY OF EVERETT BLDG DPT T0: 206 BE? 5111 FL'D 9. <br />111 11002 P.b2 <br />APPLICATILoN FOR CONSTRUC'isOW <br />PERMIT <br />05cr <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS U ELECTRIC ❑ _- <br />- <br />BUILDING DEPARTMENT <br />—__r--I <br />259-8810 <br />4_DEMOLITION I-1 COMBINATION I'I BUILDING LI MECHANICAL <br />LJ PLUMBING U SIGN <br />OWK1tn y IMit ADVnkES COO•Y� —jJ /ZIP PHONE <br />�K Ai• 1"LI'V,AnLIN t(`✓\f GC IS I(o 7:}J�•J_CLI—,jL�, -E��� 'P (iS <br />�7�(D� _ <br />TCNANT MAIL AODnESS CITY DP PHLV4 <br />AnCIRIECTOODEDIDNEn MAILAOORESS CITY ZIP PHONE <br />�7 <br />'u fT _ .._... <br />•_' <br />_.._... .. _.. <br />OENEPAI CONTRACTOR MAR AODRrOF nITY 21P PIGNE /inl[ L�K:CNOC A <br />e,w,, `(ea, ISZSO._ /J iMBn Q_...._.�I os <br />--A--.. .r1 __ <br />MrtunNKcnl cu+TRnemR unn monws eln zn PH(N+k <br />LICENSE It <br />p <br />----sure <br />CCK+i R1Wl)q MAR ADDRESS CITY ZIP PHONE <br />LtAIE LILET+iCk <br />CONTRACT Pnia WONK'00 <br />((M \ <br />OrRCRIP[ VA?RK AND LOI IAiC r W TADk INVOIVFO CONTAr..T PERSON AND PI IONC IA. <br />PROPO9rn UFF Or RUIl muc, <br />LCOAL OCLCnirTON Or rnorCn1 Y (DHOIYN BELOW OR <br />I(1T 0i OCK ­... OF <br />PARCH IAX ITT NUILICR <br />_ k3cLo Wr (90- <br />CCZTWtC- K)+ LOAN I FNDCR. AOOnESS, <br />ROJECT ADDRESS <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO OE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE 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 />CONTRACTORS LAW 18.27 RCW AND 206.200 WAC. <br />.Cr11V n[nVMPfm �// v 4• <br />UAlt <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE _ <br />WATER CLOSET (101LET) <br />C-•A'HNDLG UNITS-H.P. <br />DATHTUB <br />; <br />FORCED AIR SvSTEMS-B.T.U. IAC.A. <br />' <br />UNIT HEATERS-B.T.U. M <br />I <br />LAVATORY (WASH BASIN) <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK d DISP <br />VENTILATION FAN_T <br />-- <br />_.-_._- <br />DISEIIYASiiCR <br />__-�,_., _.... <br />i <br />-�• -- <br />' <br />........... _..L_ <br />_____ <br />_ _...... _,... •,,,- <br />LAUNDRY TRAY <br />WATER HEATER .___.._.._.__.. <br />_ <br />._ ... _.. <br />C'.OTHF.S WASHER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />' <br />' <br />URINAL <br />DRINKING FOUNTAIN <br />i <br />HEAT PUMP ..._ <br />GAS PIPING <br />• •- <br />R _ <br />FLOODRAIN <br />BACKFLOW PREVENTERS <br />I <br />_....__... <br />ROOF DRAINS-RAINLEADERS <br />, <br />EXHAUSTFAN --- <br />' <br />_._ _. _.__ _.{•.- <br />._.._..__ <br />---..--.--_ _.. .... <br />_. ' <br />$INK ISERVIC[ BAR. ETC.) <br />._ <br />SUBTOTAL E <br />I <br />SUBTOTAL E <br />__1_,•-, <br />PERMIT E <br />PERMIT E <br />-- <br />I <br />-----.— <br />' <br />`• ') <br />•- <br />TOTAL FCC $ <br />' <br />TOTAL FEE !; <br />FOR OFFICE USE ONLY: <br />rnONT SETWX I nEAn! <br />U5EZUNk <br />FINk ALAHI <br />..... __... ...... <br />... _. <br />VAf.ANi SIT[ <br />rl YES Fl NO <br />RECEIPT NO <br />FEE — <br />N <br />i <br />i kF <br />INTAKE BY —_ -._1-.PLN+DArPROCELI <br />DAiI: <br />