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APPLICATIC�I FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ,�{GAS J ELECTRIC ] � <br /> 259-8810 <br /> DEMOUTION I COMBiNATION X BUILDING MECHANICAI PLUMBING SIGN <br /> �GN�'VER1 IAAILApDR[55 CItY LP f�HONE <br /> �'"�_J—:_��I�%�f �I�C%�/#u. �31�' 1�:1 DI2 ���. �l�l-'�i� �/�i('�i 3�J�-.2�j'c�,J <br /> 1[NANT MRILA�DRESS CiiV 21P PHONE <br /> ARGHITECi OR�ESiGNER M41L ADpRE55 CIiV ZIP PHONE <br /> ���Mc.�AI I, �ftMF A� l�ll.�.'FfZ <br /> GfN[RAIC�ONpiRALTOP IdqRApDRESS CrtV ZIP PHONE STATEIILENSEv <br /> �U� <br /> IAECHANICALCONiRAGiOP IdNLADDRE55 C�tV ZIP PMONE STATELICENSE< <br /> PWMBiNGCONiRACTOR IdAItAD�RE55 GTY ZIP PHONE STATELICENSEs <br /> CONTRACTPPiCEOFWOqY, G�� <br /> �C�L/ <br /> DES/CRIECE1 W1O�RK qryND 60UAPE f1OlO�iAG[LIN,VOL/V[�D CONIDCi�ERSUN AND PMONE N0. <br /> 1��1 IW �.C�Q lV I�ITY � <br /> �YiT/ n.TT� �{�v� �.CCT'c� I"�l V�/�l�r 4-� y`�1 l �� 2�,7 !�'l/�L" <br /> i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> Pnorose.�use oFeuao.Nc AppLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eca�oes�CPfF1IQN�rPROPERtt�SNOWNBElOWO TTACNTWOCOPiES�� W�RK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> ,o, � o�ocK oF ^ .QGJJD NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE CR LUCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OY.i+ER OF THIS PROPERiY TO PERFORM THE WORK FOR WHICH <br /> PARCFl T X �NUMD/E�Ry <br /> - APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> _��—VUJ -D%y -D�O/ CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> L.'NSiqUCiIUNIOANlENOEP.ADDRESS.TEIEPMONENUM9Efl /� � <br /> ` �G�- <br /> P/ROJECT ADDRESS svii � �� <br /> lG3 �� 6J crtvouswts �wcvse�w <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> _ WATER CLOSET(TOILET) A,'C—A�HNULG UNITS—H.P. <br /> BATNTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> _ LA/ATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHUWER CLOTH[5 DHYERS <br /> KITCHEN SINK 8 DISP V[NTI.ATIqN FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UPINAL ; METAL FIREPLACE�WOOD BURNING) <br /> _ DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR�RAIN HEAT PUMP <br /> DACKFLOW PREVENTEFS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAi1ST fAN <br /> _ SINK(5[qNICE—BAR,ETC.) <br /> — �— <br /> i <br /> SUB TOTAL 5 SUB TOTAL S <br /> PEFMIT S PERMIT $ <br /> TOTAL FEE S TOTAL FEE 5 —'— <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SET�ACK 51DE SEiOPCK P�AN CHE N N�ER^ FE[ RECEIPi N0. <br /> 3 �a <br /> useiorve toTnaen vncnNrsrte FEES VALUATION FEE <br /> _ �— <br /> VES :.- NO BUaORdG _5'OD /�j � <br /> ir��EOfCaNSt. NOOFSTOPiES mc.:^Fvw �ioo�ownuxcuxus - <br /> ' PLUMBING <br /> -�A/ Z (� =�3 / <br /> SIZEOFpL�G. FlFESPRINMLERSREO'D 9FSEMENT � <br /> F.r!57'4 D <br /> VES '1/N� MECHANICAI <br /> OCCJi'ANCY LOAD FIRF ALAqM REOD NEIGNTIiMITATION ADDITION4L PLAN CH[CK <br /> �/� ��J ��/ OTHER <br /> HGASON <br /> STATE BUILOING SURCHARGE � <br /> iNinKi nv rinr�s narnoveoov CITY OF EVERETT puour,woaus � <br /> � H LOCAL SALES — <br /> onre 3 ��, q TAX CODE IS 3105 rcrn� <br />