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awlPLi�A�'iC 1 �r�� �c��[�T��c�r �n r-�r�mo � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />LHEATING SYSTEM: J GAS ELECTRIC �I <br />BUILDING DEPARTMENT —� <br />259-8810 <br />_�......��...� �. � nn�11C1AlATllltJ ���RUILDING I I MECHANICAL ��. '� PLUMBING <br />O\NNER <br />l <br />fAAll A�QRE55 <br />,,. <br />SIGN <br />3--c'/3D •-�+ <br />�c�,�� � 62 `J <br />' � <br />( t i/ /� v � ' .� ' � cm z�v " :� rNo�+c ' <br />iENI+NT n , /J MAILA��R[SS� <br />pRCNIT[GTOBDESIGNEA MAIL4�ONESS ;J CITY ZiP PHGNE �y� ' /�y�_�j � <br />/ �/JI� I'%AD% �J L�j(%�.�Li.E/�Ei�; lV/� /dG3'T_; i��II % <br />� �Si sir/ Gii//E-S /�/ Nin.? � s� <br />GFN[MLCONiFiACTOR lAAILA DFESS � CITV / � Zi�/' PMO�J[ SiAi[LICENSE� <br />/ �U' �O SL1l�i r� rr%! �/' %��OS�/3.3�-5�/. 54 � . % � iu.�' <br />,�ja,9f'S/�� <OiUST/p// /Ofv 8< < <br />��n, /Z1P �o��E svGe ucensE e �— <br />MEGHANICALCONiHAGTOR MFiLA0DRE55 <br />PLUAI�INGCONiIACTOR MFILAp�RE55 <br />GITY 21P PMONE STATE LIGENSE � <br />CONiRRCT PPIC[ OF WOflK �%I_��� � / � % /2O ' <br />CONTACT PL�i50N AND PNONE �'0. �`n�� `/� n r_�� 3� -� -��� <br />�ESCRIBEWORKANDSOURREFOOTAGEINVOLVED �y / ��� i .�_ <br />� <br />/i��l� 7G1�1�.Y- /? �(� �=/ �'-�-�c,,n c <br />Ra�l� , n �.� <br />PROPOSED USE OF LIWLOMG <br />fj'�S/J_Jc`it/%//�� <br />IEGPL JESCRIPTION Of PROPERTV ISHO\4N BELOW OF <br />LUi� BLOCK �0.�'f' <br />�'PRCEITA%ID.NUMBER <br />CONS��UGTIONLOANI[NDER.AODRE55, <br />N0. TYPE OF <br />WATER CLOSET <br />BATHTUB <br />KITCH[N SINK 8 DISP <br />DISHWASHER <br />LAUNDRV TFiAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENTERS <br />SINK <br />- �L <br />SUB TOTAL 5 <br />PEAMIT S <br />tOTALFEE S <br />FOR OFFICE USE ONLY: <br />PRONiS[TP�CH PEARSEi(iACN / <br />20� _ <br />US[20� IOT�REA <br />Z <br />11PE OF CONS7. NOAP STORIES <br />OLLUPANCV <br />INTAKE OV <br />r <br />fIF[ SPRINHlENS REO'� <br />FIRE ALARM REOD <br />PLANSAP ROV[�flV <br />N <br />on, e ��/Zv/ �Y3 <br />FEE <br />�l, c . <br />-n ���l�L l-/_JFST ' /2 9-�C� / �, <br />I HEREBV CERiIFY THAT I I1AVE 9EAD AND EXAMIIJED THIS <br />APPLICAI'ION AND KNOW THE SA1.1E TO BE �I r VE AND CORRECT. ALL <br />PROVISIONS OF LAWC AND ORDINANCES GOVE9NING THIS TYPE OF <br />WORK WILL BE COMPLETED WITFI WHETHER SI'ECIFIED HEREIN OR <br />NOT. TfiE GRANTING Of A PERI�IIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIGLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORPdANCE OF CONSTRUCTION. THAT I Ahi AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORI.1 THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA1N 1827 RCW AND 296.200 WAC. <br />5,�.v � � <br />C' ou:rv�iSUCIu' �e-) <br />- MECHANICAL <br />NO. TYPE OF <br />A'C—A'HNDLG UNI'� <br />FORCED AIR SYSTE <br />UNIT HEATERS—B: <br />CLOTHES DRYERS <br />VENTILATION FAN <br />G RANGEHOOD <br />� WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACE INSER� <br />HEAT PUMP <br />GAS PIPING <br />� EXHAUST FAN <br />SIDE SE� � PLAN CM�CK NOMtlt�� <br />3� c <br />vnc�n/Ny,�5nE FEES <br />�� "-S � N� BUILDWG <br />WGOP}yC� tA Of.A'iIUNGVN'C <br />`o.n�l, � ^� 2 PLU1.I�ING <br />i} <br />oASE 1 MECHANICAL <br />I YES P' NO <br />HEIGHT u1AiTnTioN AD�ITIONAL PLAN CHECK _ <br />Lq / <br />(/ OTHER <br />STATE BUILDING SURCHARGE <br />CI fY OF EVERETT PUBLIC WOHKS <br />LOCIIL SALES <br />rnx cooeis aios TOTAL <br />B.T.U. IA <br />M <br />SL'6 TOT�� y <br />PERMIT S <br />TOTALFEE 5 --� <br />�/ ({i n�ct:i r��iJC.� <br />VALUATION FEE <br />j3 Z� __��11�:�L <br />� � <br />i <br />_ j� <br />� <br />� <br />�)� <br />.) <br />in��_ i— <br />