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APPLICATIO"1 FOR CONSTRUCT�'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J <br /> 259-8810 <br /> DEMOLITION �OMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAILAO�RE55 QiY ZiP PIIONE <br /> Pa�� m�� �� -r v.a� �.;d�� i�� �v�ra� w� y8zos zs� -Zsv� <br /> i!'�ANi MARApDRE55 '-' CIiV 2iP PHONE <br /> ?�WtG <br /> A�ip�rtECTORDE5IGNER I.�AiLqDDFE55 CITV 21P PYONE <br /> GENCPhLCONTRACTOR MAILAD�RE55 CtTY IIP PHONE STAiELICFNSEe ' <br /> I.�CC,HANICALCONTRALTOR MAILADDRE55 �ITV ZIP PNONE SiATELICENSE+ <br /> V�U�ApINGCONTRALiOfi \ / IdqIIAD�RE55 CIiY 21P PNONE STATELICENSEa <br /> V <br /> CONiRACi PflIL[OF WORN <br /> A �✓aK 1s�0'� <br /> DFSCRIBE 1VORN ANp SOUARE FOOTAGE IN Ol ED CONTACT PERSON AND PNONE N0. <br /> �� ��� �n' �v I t11�Ke� Zsq-zs�-► <br /> I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> F^oroseouseoFeuiio�nc APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT.ALL <br /> L�V�� S �� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iecn�oescnianoNOFPaoaenTvisr+ oe� woanrtac��Twocoaies� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUIv�� TO GIVE <br /> io� k�s� a AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � i��/ D T EVGI'O�� ,SI1oY� PIQ�'. # OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> IZOZ' 3�I'fS OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> - APPLICATION IS MADE AND I COMPLY WITH THE ST�TE <br /> vnWce�raz i o.r+uuoea CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSiRUCT104LOANl[NDER.ADORESS.TELEPMONENUMB[R <br /> X—�c�.�,wl��=�– 4- �s-�W- <br /> PROJECT AD�RESS =�r;aum� - n.rz <br /> Co l�7 V;ew �-�d lk �.,.�,��s�.�s���,..,�.�..� - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> 1 WATER CLOSET(TOILET) A�C—A:HNOLG UNITS—H.P. <br /> � BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> 1 LAVATORY(WASH BASIN) UNIT HEATEFS—B.LU. M <br /> SHOWER CLOTHES DRYERS <br /> HITCHEN SINK 8 DISP � VEiv fILATION FAN <br /> DISHINASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> 1 CLOTHES WASHER WOODSTOVE <br /> URINAI. METAL FIREPLACE�WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPL�CE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOV✓PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> � SINK�SERVICE—BAR,ETC.) <br /> —�— <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S PERMIT 5 <br /> TOTALFEE 5 TOTALFEE S —T- <br /> fOR OFFICE USE ONLY: <br /> Fq011i5[iO4CK qEARSETpACN SIDESEIBACK PL/+NLNECHNUMpER FEE PECEIPTNO <br /> usezor�e LOTFFEA vncnNtsire FEES VALUATION FEE <br /> �.l YES r�� NO BUILDING �h <br /> iYPEOlLONS� NO.OFSiORIES occu�a•¢v Hawm.'Fur�Gu�.as �-L�— <br /> caau� pLUM�ING <br /> 3� <br /> SIZEOFBLDG. FIRESPR�NKLERSREO'D BASEMENT MECHANICAL � •� � <br /> "-. YES .-� NO J V <br /> OCGUPA4CYLORD FlPE�LARMREOD HEIGHiL.AITAT10N AODITIONALPLANCHECK <br /> OTHER <br /> H[nsoN �?� <br /> STAiE�UIL�ING SURCHARGE /J �/�/ <br /> � <br /> r.irnwi i;v PlANS�PPROVE00Y CITY UF EVERETT PUOLIC WORKS y— <br /> LOCALSALES <br /> on,e TAX CODE IS 3105 TOTAL <br />