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� � <br /> d��PE�i�A'@°1�� ��R CONS'TR4J��'! �'iN PERfVI1T � _ <br /> TO BE COMF'LETED IN BLACK INK—PLEASE PRINT ��� � <br /> BUILDING DEPARTtv1ENT HEATING SYSTEIA: �,]GAS J ELECTRIC J ___ _ � '"" <br /> W <br /> ��D-8810 <br /> DEMOLITION ! COMBINATION 1 BUILDIiVG xMECHANICAL PLUMBING SI:- `3 <br /> C.S�:CIl I.INLADDRE55 Cli't IIP PHONC <br /> � <br /> .D/�,��� hon�eS <br /> '� %'� MNLApDRESS CIT" ZIP PNpNE � <br /> k <br /> ,.� ��.iECiOPDESIGNER ldNLADURESS (�t'i ZIP PNONE X <br /> :�'.���+n�CONTRFCTOR �IAIIADDRE55 CITY ZIP PNONE STATELICENSEn — � <br /> i:� �' GL _meS <br /> '�'�.�.:�^.�'4LC NiR�5iOR M11q�LA0�FE55 CITY ZIP PNONC STATELICENSEk � <br /> �1 �7.5 �"�-(�/I�i�-- � �'of� 17��/�/ �e�/ `��oa� 7y7-/'1�30 13UbS�'G�% - - . <br /> . . .C".�lGCONTFM1CTOR ldAILAD'JRESS CITY ZIP � PHONE STATELICENSEtl <br /> �. .i�r,CT PpICE OF WORN <br /> ZZ�� <br /> . . �^.�3EWORKANDSOUAREPOOTAGEINVOLVE� CONTACTP[RSONANOFHONENO <br /> .�YIJ �� � �� 1r0��11 . �.o�/"��iT�- Lo ��� �� �—�Z-.L—.—. <br />� P�L��S�M _ I HEREftY CERTI!=Y THAT I HAVE READ AND EX.AMINED TH!5 <br /> ��;s��usE d w�mnc APPL�CATION AND KP;OW THE SAME?O BE TRUE ANp CORRECT. ALL <br /> PRO�/1510NS OF IAVJS AND OADINANCES GOVcRIJING TH1S TYPE OF <br /> �. ',i.oesca7lJNOFPFOPERTV�SHOWNOELOVlOR�ITiAC'iT\YOCOfIES� WORK WILL BE CJ`APLETED WITH WHETHEH SPEC.IFIED HEREIN OR <br /> NOT. TFIE GRA�ITING OF A PERMIT DO�S NOT PRESUME TO GIVE <br /> i�.:��.-� o�ocK oF��—�-- / qUTHORITY TO 'JIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> _ �� � — L�I�T/'� OTHER STATE OF LOCAL LAW REGULATINC CONSTRUCTIOIV OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUIHORIZED BV THE <br /> OWNER OF THS PROPERTY TO PERFORAA TNE WORK FOR WHICH <br /> �--- �� APPLICATIOP; IS MADE AND I COMPLY WITN 1'HE STATE <br /> r;.r;:,:��r>x i�.Nun�uea CONTRACTOF.S LAW 18.27 P,CW AND 296200 VlAC. <br /> L.�'.;:f�.1CTI0N LGAN IEY�ER.AD�RF.55.TELEPHONC Nl1M0ER <br /> - X-��'� . /OIZS�S� I <br /> -PRO;ECT ADDAESP. �...�:.:.:�..�. �� n>.c � <br /> �ir�.�n—`�su �- - �.o <br /> f LUPdBING MECHAN!CAL� I <br /> tJJ. T1rE OF FIXTURE JA I7'EM FEE NO. TYPE OF EOUIPMENT FEr_ � <br /> 1NATER CLOSET(TOILET) A G—NHN7LG UNITS—H.P. <br /> �ATHTU9 ; �'ORCED Ahi SYST[IdS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATER."+—B.T.U. M , <br /> SHOWER CLOTHES DR�cRS � <br />/ _— KITCHEN SINK&DISP ; _ VEN i i'_ATiON FAN ' <br /> DISHNlASHER �_� / RANGE HOOD r— <br /> _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOG BURNING) <br /> DRINKING FOUNTAIN FIREPLAC�INSEAT ; <br /> — — --�— <br /> FLOOR DFAIN ; HEAT PUMP � <br /> BACKFLOW PREVENTERS Z GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> — T <br /> —— — T— <br /> S110 TOTAL $ SUB TOTAL '�_ <br /> _ _ PERMIT S PERMIT E _�j I <br /> TOTAL FEE S TOTAL FEE >.'�— <br /> FOR OFFICE USE ONLY: <br /> F��.ONTSEi��GK FEAFSETII4CK I SIOESETB�GK PLAtlCNEGY.NUhlpFfi fEE H6EIPTNO <br /> u=�:urc �crnaen VACANTSITE FEES VALUATION FEE <br /> �. YES �.=i NO BUILDWG � <br /> .. CONST. NO OF STORIES ca[:•.0 Iq Ct 0'.vRtoiG uqits --- - <br /> "A°' PLUMBING � <br /> . .-F�9G FIqESPRMKLEF5RE0'D flASEIAENT � <br /> � 1dECh!ANICAL <br /> :'��. YES -_! NO - <br /> � <br /> L. .�����dVCYLOAO FIPGFLARMRE00 HEIGHiLI/ARAT10N ADDITIONALPLANCHECK i <br /> � <br /> OTHER ' <br /> ,. . nl ----i— <br /> S7ATE BUIL�ING SUfiCHAFGE i <br /> ^ ''" 1° P1r"^^°��O`1DP` —�CITY OF EVERETT PUBLIG WOPKS � <br /> LOCAL SALES �-�— <br /> r:,, � TAX CODE IS 3105 rorn� <br /> - — ——_ ,:�.�aA��I i�� <br />