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APPLICATION FOR CONSTRUCT�Oi� PERI�AIT � <br /> \/�\ TO BE Cv�dPLETED IN BLACK INK—PLEASE PRIh i <br /> r <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> 259-8810 <br /> � DEMOLITION I l COMBINATION �� BUILDING ❑MECHANICAL ❑PLUMBiNG ❑ SIGN <br /> OwNER M�ILAODRE55 CITY 21P PHONE <br /> �t� �U�Mm � COl�k�11�. @�I 1J4,'(Yt�2�, �U4�etTi- WA 902DI-ItZ� ?A6 3889513 <br /> TFNf�JP�� �/���DDqEqy�� .� CITY 5 21P PN NE <br /> 5 I 4 <br /> �'(�LLJ�r <br /> FRCMITECCOROESIGN n iriniinLuFe33 GTV ZIP PHONE <br /> wf'�FR a�'ifkl�i4.(,T�i 1� I $f�'� P�Iti }� �r.�IIi1 ,Wp 9�,19� �,f16 Z85��'00 <br /> GENERAL' ONiR�q MAILFODFESS CITV ZiP PHONE STATEIICENSE� <br /> i rn <br /> MECH�NICALC011TRACTOR MAIIAJOR;SS CITY ZiP PHONE STFTEULENSE• <br /> PLUMBINGCONTFPCTOR NqLADDRE55 CITY :IP PHONE STRTEIICEhSE/ <br /> CONTNACT VRICE OF WOPH <br /> D BE1V KnND CUFREF �{yo VED CO PERS�QI��NGP�/ �J��� �� 5,�� <br /> � �1��N ���� V�V <br /> i HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROP1OMSEC � oF i�oi �'j' APpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> V',V� _��� �� �X1�+� ?ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGAL�E:CRI?710NOFPqOPERtt�SMOWN0ELOIVORAi �HT� OCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oF 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 /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PRRLELTA<I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR R 18.27 RCW AND 296.200 WAC. <br /> ' GONSTRUC'IONLOANLENDER.ADDRESS.iELEPHONENUMBER <br /> PROJECT ADDRES _/ s�cH.rune ��rE�� <br /> CILYBlI5MES5l E Elq <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. <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 SINI(&DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ' WATERHEATER <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNIN3) <br /> DRINK�NG FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%NAUST FAN , <br /> SINK(StR�'ICE—BAR,ETC.) , <br /> � <br /> � <br /> � <br /> '—T— <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PEFMIT 5 i PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: '! # ���3 <br /> FRONTSETBFCN REARSETBFCN SIDESETDALK PLANCH�N AIBER��_ FE qECEIPTNO. <br /> Gf � <br /> USEZONE LOTAREp VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDIIJG � Gl � / 7;— <br /> iYPEO{CON51. NO.OFSTOPIES oCWwN[r No0�ow2wntuNnS `'J <br /> �� —�� PLL'MBING <br /> SIZEOFBLOG eSPRMKlER5RE0'D BnSEMENT. MECHANICAL <br /> �UD G/�Il/�� ❑ ves ❑ No <br /> OCf.UPANCY LOAO FIRE ALARM REO'D HEIGNT LIMRNTION ADOITIONAL PLAN CHECK <br /> OTHER � <br /> NEASON � <br /> STATE BUILDING SURCHARGE � '� <br /> INTr1KE[1\' P�pNS APPlIOV[D�Y CITY OF EVERETT PUBLIC WORKS <br /> lIM LOCAL SALES -�— <br /> oA,E � ' TA%CODE IS 3105 rorn� � 2 � <br />