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APPLICATI�. FOR CONSTRUCT►.1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM� I�(f GAS U ELECTRIC Q � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i I DEMOLITION I I COMBINATION i BUILDING I i MECHANICAL I 7 PLUMBING I I SIGN <br /> owr+en <br /> uni�nuoness cnv nr PHONE <br /> NANT MAILAO�f1E55 CIfV 21P PIIONE <br /> �PCIIIIECTOf1�ESIGNEP MAllA00RE5S CIIY 7.IP PIIONE <br /> �'E�RALCON7R�C10R MAILAUDRE55 ���Y zIP PHONE STATELICENSE� <br /> G / R�ii )�� //J7// F✓FD/ F.v ��A✓.EJ/�F'e��/�-Q���� Z9/I-/P/8' LLBU//� �//�P <br /> M CNANICN.CONIIUCIOR MMLADDOE55 <br /> CIIY 21f' f`110NE STATEIICENSE� <br /> PIUMBMRCONTMCiOR <br /> MMlA0�11ES5 Ci�v 71P PHONE STATELILENSE� <br /> anssorwonK �� i DEMOLITION I I WOODSTOVE/FRPLINSERT ❑ BUILDINGRELOCATION <br /> Y' NEW � I ADDITION I I ALTERATION I I REPAIR _ <br /> corancr rensor+nr+u riwr+e No. <br /> coNmnct rmce or wonK —��'�'e� f ON(� - <br /> OESC111BE WO�iN AND SOU��E fOOT�GE It:VO1.VE0 r� ��_ ���/ O <br /> J a <br /> rnoroseouseornuaoina i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br /> S/Nl�c, - �M/L �,�j APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF Ll�NS AND ORDINANCES OOVERNING THIS TYPE OF <br /> L�GALDESCfill'iIONOF�ROPEf1IY�5110WNBELOWOii�TTACHFWRGOPIESI yyOFK WILL 8E COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br /> ioT 3 B��K pF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> � � ,,_, AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> S�0 5 . �A�2� OTHER STATE OR LOCAL LAW REGULATIN6 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 /> SCGO^IU I�L Fi?J� � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS AW 1827 CW AND 296200 WAC. <br /> I`O i A l. SQ FT I Z9D x; �,E �*E <br /> pno.�cr nooness Na . <br /> Z C /� — c��rBUSmEssUctNSF.rq <br /> J C MECHANICAL <br /> PLUMBIN6 FEE <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT <br /> WATERCLOSET(TOILEO � A/C—A/HNDLGUNITS—H.P. ' <br /> � FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> 'L BATHTUB ' � <br /> 3 IAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M <br /> CLOTHES ORYERS � <br /> ! SHOWER � <br /> VENTILATION FAN ' <br /> KITCHEN SINK 8 DISP � RANGE HOOD � <br /> DISHWASHER WATER HEATER � � <br /> ' .� LAUNDRYTRAY � <br /> i WOOD STOVE —:— <br /> �_ CLOTHES W�SHER ;— METAL FIREPLACE G � E � <br /> � URINAL ;— � � <br /> FIREPLACE IN;ERT ' <br /> , DRINKING FOUNTAIN —;— $ HEAT PUMP � <br /> .8- FLOOP DRAIN � GAS PIPING . ' <br /> � BACKFLOW PREVEN7ERS �— EXHAUSTFAN � <br /> � ROOF DRAINS—RAINLEADERS — ' <br /> � SINK(SERVICE—BAR,ETC.) ; — � <br /> � <br /> � , <br /> � , <br /> _ , <br /> � , <br /> SUBTOTAL S � <br /> SUB TOTAL S �_�_— � <br /> PERMIT S ' <br /> — PERMIT 5 ' TOTAL FEE S ' <br /> TOTAL FEE $ � ��-y� <br /> l(/ <br /> FOR OFFICE USE ONLY: — �� HEGEIP o.3'/ <br /> REPR SETOACN SIDG SElO�CN PI.AN CHEGN NOMUEf1 FEEp�� <br /> FRONTSETB�CR q� / � y <br /> Z� — ��( r S FEES VALUATION FEE <br /> y� �ornnen vncnr+tsne � <br /> �SE�p (�6 N 2 .' <br /> �y„'L ��s Y I3UILDING � <br /> �� <br /> IYPEOFLON15.�«OWhBIE IYCEOFC@15I.�LN�I acurnxcr �wd'mmiuxcuans � <br /> n�ur ' P�UMBING �(-r— <br /> NO.OFSTOPIES B�SEMENT MECIIANIC�L " i <br /> 124�u�SF �'A¢ /�D 2. <br /> —� — AUDITIONALP�ANCIIECN <br /> FIRE SPfiNHIERS FlE00 IIEIGHi LIMIiNION � <br /> OCLUPANCYLO � � � � <br /> Q 51'R�IOKtER— (��� � �1 <br /> REASONFORSPt11NNLE115 $TATE�UILDINGSURCHARGE ' " <br /> ����^K��Y rinNs n noyeu ov CITY OF EVERETT rueuc woraKs 2Cr' <br /> � LOCAI SALES T�T� - 2'� 1 3 <br /> 7^,v,r0'�E!S 31�5 <br /> 3 <br />