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APPLICATIa J FOR CONS""i�UCT.JN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: I�(f GAS U ELECTRIC ❑ —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOUTION I i C'JMBINATION � BUILDING I I MECHANICAL Ll PLUMBING I � SIGN <br /> OWNEO MAILAUDqESS CIIY ZIP PHONE <br /> TENANT MAIL�DDf1E55 CIfY ZIP PHONE <br /> ARCIIIIECTOROESIGN[0 MAILAO�RESS CIIV pIP pHONE <br /> GEN R�LCONIOACTO�i M�ILAO[10E55 Giv zIP PHONE STATEUCENSE� <br /> L�G 13r�icJ�,�c �p��i F✓��p�.s�s•�.�s��✓�K�"r 1.��,��20� 29a-i�i�' cc6vii� �/P� <br /> MECM�NICALCONifiACTOB N�ILn0�RE55 Cllv Zln PHONE STQEIICENSE� <br /> PLUMOINGC0111qAC70R MMLAOURE55 CItY )IP PIIONE STATELICENSEI <br /> ctnss or wonn — <br /> NEW I I ADUITION I 1 ALTERATION I I REPAIR ' i DEMOIJTION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> COIlT�CT PEI150N AND PIIONE N0. <br /> CONifi�CTPRICEOf\YORIc ����Y �Q/vD <br /> DESGIiIBE W011K�NU SOU�11E FOOT�GE INVOWEO J^ Q p <br /> _l. Y� "�d � 0 <br /> PROPOSEDUSEOFOU!LUINO i HEREBY CE�^TIFY THAT I HAVE READ AND EXAMINED THIS <br /> .SiNl,[.���L�/ �(�C�^�-Q APPLICATION AD'J KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEG�LOESCRIPIIONOFI'p00[BIV�SNOWNBELOW011ATTpCIIFOURCOPiEsr�l Y�tT'— PROVISIONSOi�IAWSANDORDINANCESGOVERNINGIHISTYPEOF <br /> WORK WILL BE COMPLETED W�TH WHETHER SPECIFIED HEREIN OR <br /> toi e�ocK' oF — NOT. 'fHE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Mai�I�L, 9�Z ,5�, � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> O 5 fT C OTHER STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION ORiTHE <br /> * / PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> S C GON U }�L (O�S , 3 8 0 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> - — APPLICATIO IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC LAW 1 27 flCW AND 296200 W C. <br /> oiA c. 5 FT � 3 7 � <br /> FROJECiADOqESS •r+nrunE / M <br /> ��ll�— 2ncl I�� S f _ �,�.o���ESs���,SE�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) ¢ AIC—AIHNDLG UNITS—H.P. � <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. `_ <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CIOTHESDAYERS � <br /> / KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD i <br /> � LAUNDRY TRAY ; WATER HEATER � � <br /> CIOTHES W.4SHER WOOD STOVE i <br /> URINAL � METALP!REPLACE G � E G� i_ <br /> _.� DRINKING FOUNTAIN _� FlREPLACE INSERT i _ <br /> � FLOOR DRAIN � HEAT PUMP � _ <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRA�NS—RAINLEADERS � EXHAUST FAN � � <br /> � S�NK(SERVICE—BAR,ETC.) ; <br /> -- i <br /> � <br /> � � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S SUB TOTAL S ' <br /> PERMIT $ PERMIP S i <br /> TOT�1L FEE $ 'OTAL FEE $ � <br /> FOR OFFICE USE ONLY: C� � <br /> FHONTSETB�CN PEAPSEI��CK SIOESETB��It PlA/N/C11E^CK7NUMBEO FEE _ PECE TNO. <br /> �' zO � ,� 'Y�/�� \� ..� <br /> USEZONE ^7 �oTnnen VACnNiSITE FEES VALUATION FEE <br /> - `� � y �UILDING ��l <br /> tYPkOFLONIS.AIlOWAOIE 11PEOfGON57ACIUAI aainxn rvoaoxlu�xtmr��5 � <br /> _ J �° 1 PLUM8ING � i <br /> 52E lX 9l OG. NO.JF STOOIES BASEMENT h{ECNPNICAL � <br /> i5'"5 Sf 2 NO <br /> � ' <br /> OCWP/�NCYLO�D FIf1E5PRNKlER5PE0'0 HEIGNiLIMITATION AD�ITIONALPLANCHECK i <br /> �r�a ni o � �,,,,� � <br /> , <br /> , <br /> R6150N fOfi SPRINKLERS — <br /> STATE BUILDING SURCHARGE i� <br /> INTANEBY PLANSnPPROVEDOY CI7Y OF EVERETT PUBUC WOfiKS `� — <br /> .,J� � LOCAL SALES , <br /> 3 �s TAX CODE IS 3705 T�*�� �j�; � <br />