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APPLICATIO. . FOR CONSTRUCTt �'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> fiUILDING DEPARTMENT HEATING SYSTEM: GAS p ELECTRIC U <br /> 259•8810 � <br /> ❑ DEMOLITION C] COMBINATION CJ BUILDING L3MECHANICAL U PLUMBING I l SIGN <br /> �O ER MAIL��DNESS 1i5 CITY ZIV VMONE <br /> �r'�d �IA.rG� �-t��TLcLA�IP �IvE �I/ERE7T' 9$20i .ZSZ- � 7dD <br /> TENANT MAiLA00RE55 GITY 21P PHONE <br /> �RGHITECTORDESIGNER MMLADDFE55 CITY 21P PMONE <br /> GENEMLCONTR�LTOR MAIL�DDRE55 GITY 21P PMONE ST�TE4GENSEI <br /> MECNMlICALCONTMCTOR MAIL��DRE55 CITV 21P PMONE SiATELICEN5E1 <br /> �LE v� S�c��� Sh�e�e� U�1�e�� L 5 � <br /> PLUMBIN6 ITRAGTOR M�ILAODPESS CITY ZIP PHONE STATELICENiE• <br /> C ACT E �RK <br /> DESGflIBE RNANDSW�REFOOT�GEINVOLVEO CONT�CTPERSONANDPHONENO. <br /> , =crRrc rc, GAs c�M v <br /> I HERE9Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rao seo us oF aoirm� / APPLICATION AND KNOW THE SAME TO BE TRUE AND WFiRECT.ALL <br /> �Z��'/VCE PROVISIONS OF LAWu AND OflDINANCES GOVERNING THIS TYPE OI <br /> LEG�LDESGRIPTIONOFPROPERTV�SHOWNBEIOWORATT�CMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> i�r B�ocK � NOL THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVL <br /> AUTHURITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THL <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICh <br /> APPLICATION IS MADE AND I CO LV WITH THE STATC <br /> , PARGEL T�l(I.U.NUMBER CONTRACTORS LAW 18.27 RCW AN . 0 W <br /> CONSTflUC710NlOANLENDER.A�DRE55.iELEPMONENUMBEP <br /> , ,3a-9/ <br /> PRQIECT ADDRESS s `�� <br /> cnr e�siHEss ikc�+sc xo <br /> PLUMBING MECMANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—lVHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.LU E.A. <br /> LAVATORY(WASH SASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY / WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL fIREPLACE(WOOD BURNING) <br /> ORINKING FOUNTAIN / FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTE75 ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERV�CE—BAR,ETC.) ; ' _ <br /> � <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ � PERMIT S ' <br /> TOTAL FEE $ ' TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> fPO:'T SETBALK RE�R SETBACN SIDE SETBRGN PIAN GHEC MIMBEP / FEE A[GEIPT NO. <br /> id NJ <br /> u5[zorvE LOT�RE�t VACANTSIiE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUi�DiNG <br /> 7VPEOFCONSi. NO.OFSi00lES otcovwtr xotimttuMGUNns <br /> 4R01P pLUMBING � <br /> SIZEOFBLW. FIPESPRINKLERSREO'D 9�SEMENT MECNANICAL L ' (� <br /> ❑ YES ❑ NO � <br /> OCCUPANGY LOAO FIRE RLARM PEOD MEIGHT LIMITRTION ADDITIONAL PLAN CHECH <br /> OTHEH <br /> flEA$ON �— <br /> STATE BUILDING SURCMARGE � <br /> INTANE BV PLANS APPROY[D BY CITY OF EVERETT PUBLIC WORKS � <br /> LOCAL SALES <br /> DATE TAl(COOE IS 3105 rorn� _ <br />