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APPLICATION FOR CONSTRUCTInN PERMIT <br />TO BE COIBPLETEO IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT BEATING SYSTEM: GAS J ELECTRIC J _ <br />J <br />259-8810 <br />i I DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING I 1 SIGN <br />DRMER MAC IMPES5 CIEY LIP Mr E <br />r/ f�rnt�n y��5 SCGhuLSJ Y�JL £Jk�iG�n3 33743+to <br />\`\ <br />AMAIESS CITY <br />MAC ADDRESS <br />MY f <br />Im P.,DNE <br />CWR CTMC"C+MO� <br />II <br />iLIL 11,, <br />JIUU <br />Df MWJRM MO SOVARE+NIAGE M'OLVED <br />CpMtACT MILS AND PRDNE NJ <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 HENEIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT 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 THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 DCW AND 296 200 WAC <br />- <br />x•�P+'/�GtJ a�xkL {.� 8��7�93 <br />MKWOSEDLSE RegDmD <br />LEUAl MKPJPTA]NOE MR Cl. ISNTYN KLOWOCAITAHTYIGCOP4Sl <br />Lot-- BLooK a <br />'— <br />v.RLEI *�+ m Nuue[R <br />CON5IRMCTOI LOAN LEMMIl ADDRESS TELEI-O lRUMMS <br />5cg <br />PRO EC__Ct 1T�REtJrG <br />i LI <br />—Twl oal <br />— <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C—MINOLG UNITS—H P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNITHEATERS—B.T.U. 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 />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />L <br />PIP^_PLACE INSERT <br />FLOOR DRAIN <br />:AT PUMP <br />BACKFLOW PREVENTERS <br />IS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />_ <br />HAUST FAN <br />SINK (SERVICE —BAR. ETC.) <br />SUBTOTAL £ <br />_ SUBTOTAL S <br />_ <br />PERMIT E <br />PERMIT f <br />TOTAL FEE £ <br />TOTALFEE E <br />FOR OFFICE USE ONLY: <br />FROM SETBACK <br />REAR SEIBACP <br />SIDE SETBACK <br />RAN LNECM NMM9ER <br />fEE <br />RECEIPE NO <br />USE IONS <br />LOT AREA <br />veDANI SITE <br />YES NO <br />FEES <br />VALUATION <br />FEE <br />BUILUING <br />TIM CWC51 <br />NO MSTOCTS <br />IXx,PMR, KIF CnIlrv4-yIl <br />• <br />PLUMBING <br />r <br />Sa0'Sum <br />FMESPH.LERSREDD <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />- — <br />ADDITIONAL PLAN CHECK <br />---- <br />OWMPAKYLOAD <br />FME ALARM MOD <br />KgMLMITATKMI <br />OTHER <br />REASCI! <br />STATE BUILDING SUPCHARGE <br />T <br />NTAKEBT <br />PIAKSAMMh O0Y <br />IMiE <br />CITY OF EVERETT <br />LOCAL STILES <br />TAX CODE IS 5105 <br />PUBLIC WORKS <br />TOTAL <br />