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APPLIC/�TIQ"�! FOR CONSTRUCT'lN PERMIT � <br /> ` TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ]ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOUTION �(' COMBINATION� � I BUILDING i 7 MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEF �.� ��, C^� 2iP PMONE <br /> �res �+�,ov �2361 9�R��� FdMon�lc Lu�9�dza �� �iSo2la 3 <br /> �N� - ��MRiL RDORE55 CITV ZIP PMONE <br /> _ l/�/•vv <br /> RRCMIiEGTOROESIGNER MAIL OR CITY ZIP PMONE <br /> �I�ores �AV�,�E�uma�,r�chSt 9µ�.b KA�rereQhu.�S SQn-t"�i���/1cY�'It� <br /> GENERALCONTR4CTOR RDDRESS CIiV 21P PMONE STAT6LILENSE• <br /> .�(v r,�"i�. <br /> MECMANICAICONTqFCTOR MRILADDPESS CITV 21P PHONE STRTELICENSE� <br /> ��,1AIP�_%e ��t¢emi nled <br /> PLlIN94;.�{,npiq�70R MAILA�DflE55 CITY 21P PHONE STFTEIICENSE� <br /> n � , �� /r i � <br /> CONTRAGT PPICE OF WO <br /> � 5'� 0 <br /> DEFGRIB Y RKq SOURREFO:IT EI VOLVEO � � CONTAGTPERSONFNDPNON No _745_a123_7u3�3ri <br /> � <br /> ��-u^ � �x ��Y' � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUIID�IoNG- �_�n_ _- pppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��Cil._G[..C� �� �"'�^'�'�— PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGRLDESCRIPTiDN ROPERTV�SHOWNBELOW ATTRCHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT ' etocK oF qUTH091TV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �,(J, ��in,�y,�- �a,� OTHER STATE OR LOCAL LAW REGULATING CONSTHUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEA OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Pnac �rnx i.n N�uue�ea CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � �g�J.��}.O�S_ G � ) �/7 <br /> C(N15TRUCTION LORN LENO[R �pORE55.TEIEPNONE NUMBEH I� (O��aYb 5 n( � _�/ 1+�J4' -�-J I " <br /> utAM«aL. (o�n1 Wc l�l � x iior-cx.Es� <br /> PROJECTADDHESS /L ��� n sm�uAe w�c <br /> {.!� /"� arrouvncssuc�Hscrvo <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF fll(TURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. i <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP V[NTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTflAY WATER HEATER <br /> CLOTHES WASHEH WOODSTOVE <br /> URINAL � METAI FIREPLACE(WOOD BURNING) ��g <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP f i <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETQ) � <br /> i <br /> — � <br /> SUBTOiAL $ SUBTOTAL $ ; <br /> PERMIT 5 PEFMIT $ <br /> TOTALFEE 5 TOTALFEE $ <br /> FOR OFFICE USE ONLY: sr+iv�c� p��C�;>2S /"..,EC��D 2�o U4L <br /> FRCNiSEiBRCN REAPSETBRCN SIDESET9AC PLANCHEC NLMBER FE[ � RECEIPT <br /> ?� � � SLi'/� �IJ a ��� <br /> use:,pqlev � toTnAen vnenHtsite FEES VALUATION FEE <br /> C_. � VES IJ NO BUILDING 57 3�+P ����� ;�— <br /> ivPEO'CONSi NOAFSTORIES actu�evcv xoo�pWuvxc�v'S '� <br /> `� I �p^� I PLUMBING �/ <br /> i.' <br /> 512[OFBIj�GE �O�' FIPESPRMNtER5FE0'D BASEMENT � MECHANICAL ,f� :� i�� � <br /> I1ru t� Sf a� �J �_. VES iLNO — � � <br /> oCCUPnNGY�onD FlaE ntnaM RW'D HEIGHt`IMrtAT10N f ADDITIONAL PLAN CHECK y <br /> p �'� �� OTNER <br /> REASON <br /> .i___ <br /> STATE BUILDING SURCHARGE � , '1 <br /> INTRKE BY Pi ANS/PPiOV 0 BV CIiY OF EVERETT PUBLIC WORNS <br /> c� LOCALSALES <br /> onre �I' �� TAX CDDE IS 3105 TOTAL �� � ��,,n <br />