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APPLICATION FOR VrONSTRUCTI�IN PERMIT � <br /> TO BE CGMPLETED IN BLACK INK—PLEASE PRINI <br /> BUILDING DEPARTMENT HEATING SVSTEM:�GAS J ELECTRIC J_ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION f 1 BUILDING �MECHANICAL ❑PLUMBING C: SIGN <br /> �P � WIIlIDFE55 �m1 � Cliv �2�� wOMf <br /> �tPr �CY�c, rd �.cCt� r1�e f��i �R�O� 3��-01'�3�/ <br /> rzruh. M•t.00n[ss cn. no rr.a.c <br /> rl 1'A <br /> APCH1I�L}ppp[5�6NEM Y�4I�WNE55 CRY IiP ONy1E <br /> �1 � �� <br /> OFNENK�N�Cipi WIADDRE55 C�iV Ziv VrvWE Si�iElKEMSE• <br /> i; 1 JLl <br /> �KK`CpH��fOP M�l�WNE55 [�rv Iiv vrqN[ S1�IEliCENSE• <br /> 1 � 1 <br /> PyL4BMOCWiNK10q WlWOA[55 CItY Dp �MOME Sf�tElCEMSE• <br /> n <br /> "�„��o <br /> o¢s�weE wda.xo sau��rro+.ae Mvav[o conr.c.vcnsw•xo vwvE rro <br /> �'�.\l,�cC In�S <br /> I HEREBY CERTIFV TMAT I HAVE RERD AND E%AMINED THIS <br /> qw /euaono APPLIGATION RND KNOW TME SRME TO BE TRUE AND LOPRECT.ALL <br /> �- 1 PROVISIONS OF IAWS AND OROINANCES GOVERNING TMIS TVPE OF <br /> �¢puu&;pimqHa�euooE�*r�SrqwHefiowa+rtucnrwoco✓�Esi WORKWILLBECOMPLETEDWITMWHETHERSPECIFIE�HEREINOR <br /> NOT THE GAANiING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ipt xa:n or pUTHOR�TY TO VIpLATE OR CANCEL THE PROVISIONS OF RNV <br /> OTNER STATE OR LOCAL LAW REGUTATING CONSTPUCTION OR iHE <br /> — PERFORMRNCE OF CONSTRUCTION.THAT I AM AUTMOfi�ZED BY TME <br /> OWNEF OF TNIS PROPEHTV TO PERFORM THE WORN FOR WMICH <br /> APPLICATION IS MADE ANO I COMPLY WITH TME $TATE <br /> rexF�t�u o MwBEn �O/NTP'�RCTORS LAW 1B 27 RCW AND 29G.20/0 WAC. <br /> CCNSfPUCipNIO�NIFMOENI.�OME55.iElE�'JMENWBER _�( � �� ' r���YC.1"/+�-'�'� <br /> Y`7 � o.n <br /> vna "�°°r ( ,• �i f, <br /> +IlSS�KtiA'�] <br /> VLUMlINO MECNANICAL <br /> NO. TYPEOFFl7CiUNEORITEM FEE N0. TY'•20FEQUIPMENT FEE <br /> WATER ClOSET(TOILET� A CrR NNDLG UNITS—HP <br /> B�THiUB FORCEC AIR 3YSTEMS—B T.U. M EA. <br /> LAVRTORY�WASNBASIN� IINITMEATERS—BiU M <br /> SHOWER CIOTMES OAVERS <br /> KITCHENSINK6DISP ' VENTILAiIOtiFAN <br /> OISHWASHER FFNGE HOOD <br /> LAUNDRY TRRY WATEF MEAIER <br /> CLOTHES WASHER WOOD STOVE <br /> URINRL METAL FIP=PInC E�,WOOD BURNINGI <br /> pRINNING FOUNTF�N FIREPI/.CEINSEFT <br /> FLOORDRAIN MEATPUMP _ <br /> OACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAMS—RAINLEADEFS E%MAlIST F�N <br /> SINK(SERVICE—B�R.ET0.) -� <br /> SUB TOTAL S SUB TOTAL f <br /> PEPMIT E PERMIT S <br /> TOTALFEE f TOTRLFEE b <br /> FOR OFFlCE USE ONLY: <br /> fNLN15fTBILF PE�RSC10�Cx $DE$[IO�CM �I�NC��tLxNUUBLn / (Ef A[CF�PiNO <br /> U�� !�'. <br /> us[xanc �m�uu v+:�r�isn[ FEES �ALUATION FEE <br /> " � YES NO BWIDiNG <br /> �p y�y5� M OF SfCRiFS t�L+K� n0 V PNi�.^/..y�s <br /> �'� PLUMdING <br /> SiIlCiM06 fINE5P11NMlEASPEOO BLSFMFNI YECNANILAL J•D' ' <br /> ,'. YES - NO — <br /> accuru,c�or.o F�Acu•nuacoo MEw«r�wn.*wn �ooitioNuauHcr+[cK <br /> OTHER � <br /> RE/.90M —T <br /> STQE BUIL�ING SURCHARGE <br /> �,u�E�r runs�wnovcoev C:' �EVERETT Pueucwonrcs <br /> l"�L SIILES <br /> o.*E TII%` AE153105 roui <br />