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APPLICATIO.. FOR CONSTRUCTLiN PERMIT PrP'L <br />r� EH„P,�„ TO BE COMPLETED IN INK -PLEASE PRINT <br />CITY Or <br />evereEP HEATING SYSTEM: AlGAS UELECTRIC U <br />tt <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING MECHANICAL _ PLUMBING SIGN <br />ON 11 INi-Af1t1R[ss CRY zro PM]NE <br />h,lC r A,r( <br />TENANT MAC ADg1ER5 cm ZM I PrgNE <br />RUMBMB CONIRLCTON MAC AMMAN, CITY SIP (NONE LKENSE- <br />CLA550r WORN <br />NEW >'ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE,FRPL INSERT BUILDING RELOCATION <br />D0IRRACTPRLE OE WOIA l f'pp, a0 <br />CONTACT RRSON AND R X'n <br />�1(C�?/•'S zil1 7V7- ?,f Y1 <br />DESCRIBE WORK AND SO'JARE FOOTAGE MOLYE0 <br />nLl p $ fE 4,iee ! <br />PAGNSEO . BUADNG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES 110T PRESUME TO GIVE <br />AUTHORITY 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 THE <br />OWNER OF THI!- PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC W AND 296.200 WAD. <br />SIGNAYURE a CONTRACTOR OR AUTHpIGED AGENT DATE <br />i ^ <br />x U <br />LEGAL DESCRIPTION OfPR'JETRTY IBIIUTAN BELMOR MUICH'MR CGprtSI <br />LOi BLOCK a <br />Rp1ECT ADDRESS <br />//t )o C T.�r / ,I�� <br />ApRGNTSCITY BUSH BIKE IY NOAN0005ME55 ME <br />LUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />N0. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET;TOILETI <br />p <br />A G-A'HNDLG UNITS-11 P <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />_ <br />URINAL <br />METAL FIREPLACE A CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL E <br />SUBTOTAL E <br />-'7 r1 'Op <br />PERMIT 9 <br />PERMIT 6 <br />S )�Od <br />TOTAL FEE 6 <br />TOTAL FEE $1 <br />EK-S Inn <br />FOR OFFICE USE ONLY: <br />HIDNTSETBACN <br />PEAR SEIBACN <br />69F 61— <br />RAH CN CANJMBLR <br />�11 <br />RECEIPT NO <br />USE ZONE <br />OJT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />TN v wS ALtmmE <br />n", U, O NST KN4 <br />r <br />6w <br />NI V MTNR41Tn <br />SOEDFBLDG <br />wITT STORIES <br />BASEMENT <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />IX%LRNICY LOAD TIRE SPPIALERS REOD PEIGMWUATION <br />REASONF SPRIALEBS <br />OTHER <br />STATE BUILDING SURCHARGE <br />T— <br />INTAKE BY <br />RANSAWAC BY <br />CITY OF EVERETT <br />LOCALES <br />T. CODE IS 3105 <br />PUBLIC WORKS <br />r <br />TOTAL <br />gs :Do <br />