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APPLICATION FOR CONSTRUCTIVN PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—?LEASE PRINT <br /> HEATING SVSTEM: U GAS U E!.ECTRIC � N�N� <br /> BUILDING DEPARTMENT <br /> 259•8610 <br /> i ! DEMOLITION � COMBINATION X BUILDING MECHANICAL PLUMBING SIGN <br /> pyMEp M�RADDRE55 CITY ZiP PMONii <br /> -r�F6 �cidc ce., P. o. Box S7dl Y►'+�S �!�-7� .sec+�7z.,��w,►.q/�zy 3vz-�'17r -- <br /> TENANT MAII�DDRE55 i ��Tr � 21P P��` <br /> S�-r+�6 <br /> ApCHITEGTOR0E51(3NER MAILADDRESS CIiY 21P PHIX.E <br /> �usr��✓ u� r►e�r ���, g��s w Ev��c7�w�} . 94��/ 2-90-9� 7'+- <br /> OENERQCONTR�CTbR MMI�DOREFS CITV ZiP PHON= STATEIICENSE� <br /> yA-�sn�+ c�. �¢vsr� eir s» �v s <br /> MECN�NICQCd1TRAGTOR M�I1�bDRE59 CITV ZIP PHONE STAiELICENSE/ <br /> PLUMBINOCONTR�CTOR M�ILADDRESS CITY 21P P�E STATELICENSE/ <br /> C SSOF WORK <br /> i NEW I I ADDITION ' ' ALTERATION � REPAIFi . � DEMOI ITION �� WOODSTUVG/FRPL INSERT �� BUILDINO REIOCATION <br /> CONT�GT PERSON I1ND oMONE NO. ?� <br /> CONTR�CTPRICEOFWORK J �. ��"'_ L6oNw�.A �'�TF.��ol�+f�'•� ZL���I L� <br /> DE9GRIBE N\7RN AND SOU�NE FOOiAOE INVOIVED <br /> �9twa�►�✓6"'T ��P6� <br /> rnoaoseouseaveuaomw I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> �DL���� C�u���G� AppLICATION AND KNOW THE 3AME TO BE TRUE AND(:ORRECT.ALL <br /> LECULDE6CRIGTqNOFPiIOPERttISMOWI�BELOWOR�TT�CHFWRGOolE51 PROVIS�ONSOFLAWSANDOROINANCESGOVERNINOTHI3TYPEOF <br /> WOHK WILL BE COMPLETED WITH WHETHER SPECIFI�D HEREIN OR <br /> �ot e�ocK � NOT. THE Gt1ANTING OF A PERMIT DOES NOT PREStIME TO G�VE <br /> AUTHOFITV TO VIOLATE OI� CANCEL THE PHOVISIONS OF ANY <br /> OTHER STATE QF LOCAL LAV� REGULATIN6 CONSTRUCTION OR THE <br /> - — PERFORMANGE OF C(.i��oT^UCTION.THAT I AM AUTHOHI2tD BY THE <br /> OWNER UF THIS PROPFr7TV TO PERFORM THE WORK FOR WHICH <br /> APPLICATI�N IS MA�E ANO I COMPLV WITH THE STATE <br /> CONTRACTURS lAW 18.27 RCW AND 296200 WAC. <br /> X ' . �^�a� /O/�11/ _ <br /> 6qM�i�IRC WlE <br /> PRQIEC7 AODREBS _ <br /> '3pp7 (IV. �i+�l/ w/O �p. �'V�A.�n" urveusn1css�krrrsErro — <br /> ���� MECNANICAL <br /> ►Ip, TYPE OF fl1ITl1RE OR ITEM FEE N0. TYPE OF EOUIPMENT FE_T <br /> WATER CLOSET(TOILET) � A/�A/HNDLG UNITS—HP. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATOflV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN _ <br /> UISHW�\SHER � RANGEHOOD _ <br /> LAUNDFV TRAY � WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URIIJAL ' METAL FIREPLACE 8 CHIMNEV ; _ <br /> DRINKINO FOUNTAIN � FIHEPLAGE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS � 45 PIPING <br /> � q00F ORAINS—RAINLEA�ERS � �XHAUST FAN _�— <br /> SINK(SERVICE—BAR,ETC.) � — � <br /> � — <br /> � ' <br /> � ' <br /> — � <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT S PERMIT S � <br /> TOTALFFE S ' TOTALFEE E ' <br /> FOR OfFlCE USE ONLY� RECEIPT NO <br /> FRONT BETBACK RE�A 6ETB�f.N S�DE 6ETB�CR VLAN CHEGK NUMBEP FEE <br /> y� ga S"f o� ,L- <br /> us�za+E ��*�q'� VACANT 61TE FEE9 VALUA110N PEE <br /> suaoirro •3 Sn,oo, /S�`f � So <br /> TYYEOiCONiSALLOW�BIE 1�PEfMGUN57ACN�l �a r �a�������r� p�UMRINO � <br /> -r <br /> i <br /> BIZE Oi 6L00. NO.Oi STORIE9 &SEMENT MECHRNIC�L i <br /> ADDITIONAL PUN CHECK / P � Ya' <br /> ��pµ�y�p�p FIRE6PRNNlERSREQ� HEqHTLIMITATION � <br /> SPiiINKLER � <br /> RE�SON FOR fiPRINKIERS <br /> STATE BUILDINO SURCM�ROE 'SZ <br /> MT�NE BY P S�VPIM.'ED BY CITY OF EVERETT PUBLtC WORKS � <br /> LOC11L SALES � <br /> TAX CODE IS 3105 *oT�< <? s°3 ; y3' / <br /> J <br />