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APPLICATIC'i FOR CONSTRUCT'"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS �J ELECTRIC .r,] --� <br /> 259-8610 <br /> ! DEMOUTION i 1 COMBINATION i BUILDING : MECHANICAL I !PLUMBING !_1 SIGN <br /> OWNER !d/iL�DDRESS CITY ZIP pMONE <br /> �KbOc�t�t) L�96eo�1 �o3o-L 1ST Dti 9E EueRH wn 981oy rr2(.11°� � <br /> TEN ( / / �AILADUP[55 �� CiTV ZIP PHONE � <br /> \.a,t-fe, � � � �n , <br /> J <br /> AR(IMIT�C�Ofi�E51GNER MAILApDRESS GTY ZIP ONE <br /> l(73y�/ <br /> GENEFALCONTPACiON MAiLp�ORESS CIiV ZIP PNONE ST�iEyC[NSEn <br /> �. o Nfi � t9 � <br /> IAECHANI L WNTRACTOq IL qD RE55 CIiY 21P PHONE STATE LILENSE/ <br /> (�[v v � , _ �� Stil� <br /> PlUM81NG f,01liRACTOR MAtt P�IDRE prv 2iP PHOHE STATE LICENSE s <br /> CONTFA T PRICE OF WOFN <br /> ��� <br /> DESCRIBEWORNANDSQU EFOOTAGEINVOWED ��J�A s NTACiPERSONANDPNONENO. <br /> �- � L I.� t �� ' 7(r - <br /> �'II-i . i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEpU eoFeuaoinc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�L�ESCRIPTIONO�PFOPERTVISNOWNDELOWORATTACNTWOCOPI[5) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> r NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocrc oF � C � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAV✓REGULATING CONSTRUCTION OR THE <br /> PERFORM1IANCE OF CONSTRUCTION.THAT I AA'AUTHORIZED BY THE <br /> 3 �„���1 ��'a OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNI�H <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I D ilUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ✓' <br /> � � CONSTRUGTIONLOAN�NOER.AUDRESS.TELEPHONENUMBER �j�� / <br /> S� , jr �s <br /> '- PROJECTADDRESS sc.unnec o.re <br /> ! arrous�xt �uurvsn�o <br /> ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—ArHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—O.T.U. M E.A. <br /> LAVATORY(WASH BASIN� / UNIT HFATERS—B.T.U. M <br /> SHOWER CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> 1?ISHWASHER RANGE HOOD T— <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) �— <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP T— <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,El'C.) � <br /> � <br /> SUBTOTAL $ SUBTOTAL 5 <br /> PEflMIT $ PERMIT 5 <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: n.tvL �c-��� �.-L <br /> FRONTSEi�FCN qEAFSETBACK � SIDESEiDALN PL�NCHEL NUMBER FEE RECCIFTNO. <br /> '2.� � Zd � � 03� <br /> usezor�e r/ �ornaen vacaNrsire FEES VALUATION — FEE <br /> � �l YES '�-� N� BUILDING .�_ <br /> iPPEOiCONSr NOAFSTOFiES oCc�cpp��r imo�DwEu�xeumi5 i <br /> �P�e° PLUMBING �� �� ' <br /> �� <br /> SiZEO� IOGY FIRESPRINKLERSRW'0 O�SEMENT MECHANICAL <br /> I1��'Z`� ves - No /�-� ac7 <br /> OCCUPANCVLGAO FIREALAqMREO'D HEiGM�TL�IMITAT''ION' ADOITIONALPLANCHECK 0 <br /> �Q v ✓ OTHEii <br /> n[nso�+ <br /> STATE BUILDING SURCHARG'c / i /- ) <br /> iNTAKG OV PLANSAPPROVEDBV CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> onie �� $ TAX COUE IS 3105 torA� �7� �(r� <br />