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APPLICATIC'1 FOR CONSTRUCT" �N PERMIT � <br /> TO BE COMPLETED IN BI.ACK IMK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC S� C�M� �s CT �A--� <br /> 259-88'�0 <br /> DEMOUTION COMBINATION BUILDING }QMECHAN�CAL I PLUMBING SIGN <br /> NER MAILADDRE55 CIiY 2'P PiDNE <br /> �vE�lr(�n..M Co(l:r�e B�( YI�P�F+� Ev�'�t 987.01 <br /> iEN�NT MAILADDN[55 CRV 2iC PN��NE <br /> AR NIiECTORDESiGNEg IdAILADORE55 � CITY 21P PMJNE <br /> A�Q�,s��r�� ce33 a c�, ��,Wh 9��33 ��6� SZ7-�s�� <br /> GENERALLQYTRACTOq MNLADDHE55 LiiY ZIP PIIONE STAiEUCENSE• <br /> �GHqNICRLGONiRAGTOR M1tAiLqDDR[55 qTY 21P PHONE STATEUCENSE� <br /> 7r� h _ � �{�,tvmne�. .�o.r ����P N m 1 <br /> PLUMBINGCONTHPCiOR MMLAODRE55 GRV ZIP PHONE STAT[IICENSE• <br /> CONTR4C1 RICEOFWORN <br /> � OOO <br /> OES RIB° 0 K AND OUA FppTAGE INVOLV D CONTPC P RS N AND PH E NO —����� •��� <br /> QawelrsN �i ��v ES /�D �t�c� a��ttr - �So►� � uc ; <br /> W�YPa.•r�swc't�y [�rl�tb�. 1 Gi�s /�p Zob 5L — 0501 <br /> i�0� �IR L HE�i ll(M� D � I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PPOPOSEOUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCR�PTIONOFPpOPERTY�SHOWNBELOWORATTACIITWCCOP�ES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOi-- BLOCN 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 1 AM AUTHORIZEU 9Y THE <br /> OWNER OF THIS PROPERTY TO PERFOPM THE WOpK FOR �VHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRCEL TA%I D NUMBEP CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LORN IENDER.ADDPE55.TELEPMONE NUMBEP ( ,�� / 1`J11 � � <br /> \/ �/ `� � � � /�_/�� <br /> I[ <br /> PROJECT ADDRESS - i.v.mee p,.¢ 7 <br /> Cirv 9W�rvE55 cG[NS[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE:�E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—A/HNDLG 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 CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL METAL FIREPLA^.E(WOOD BURNING) <br /> GRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> _ BACKFLOW PREVE�lTERS GAS PIPING <br /> ROOFDRAINS—FAINLEADERS � EXHAUSTFAN , <br /> SINK(SERVICE—BAR,ETG) ; <br /> / / <br /> SUB TOTAL $ SUB TOTAL $ � <br /> PERMIT S PERMIT $ <br /> _� TOTAL FEE S TOTAL FEE $ L 'f <br /> FOR OFFICE USE ONLY: <br /> FRONTSEtpACN REARSETBlCH SIDESE7BALK PL�NCN L N MBER F[E RECEIPTNO. <br /> / <br /> use zorve ioi aaen vncaNr sire FEES VALUATION FEE <br /> �, YES i 1 NO BUILOING <br /> 7VFEOFLONSi. NO-OFSTOFIES ncLunvcv rmoipwu!ixcurvrt5 <br /> "�'��' PLUMBING <br /> i <br /> SIZEOFBIDG FIRESPRINNLERSREOD BFSEMENT MECHANICAL i <br /> :- YES .-�. NO <br /> OCCUPANCVlOAU FiREALARMREOD HEIGNiUMITATION ADD!TIONALPLANCHECK <br /> OTHER <br /> REr1�ON <br /> STATE BUILDING SURCHARGE <br /> INTAKE 8V PLANS.qPPRO'JEO BV CITY OF EVERETT PU9UC WORK$ i <br /> 1M LOCALSALES <br /> �,�,;� � �3 c�� - TAX CO�E IS 3105 rora� , <br />