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�._.� � :�.;: :��n�-� <br /> APPLlCATIC- 1 FOR CONST'I�UCT'"'1N PEP�iVI1T �,;,� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HE�,71NG SYSTEM: �G�S IJ[LECTRIC ❑ <br /> � -- <br /> 259-8810 <br /> I I DEMOLITIOIJ I I COMBINATION I I BUILDING ?QMECHANICAL ; I PLUMBING U SIGN <br /> pYlIIER IdNtAUCtifcS �—�— CI1V---�'" JiP.. "--- PkIONE _-- —" <br /> A�.�c.sr y_F�/LR•Slts_�s11e—Y_?_2���'�_ErEKEZr�gloa o7sa -f/sl•,�' <br /> rFun�+r inni�noonc^..: a�v �m ruoNe <br /> nnGnlECronoF.9;:FiEH rAnllnDOnFSS Cpv zIP FliorlF <br /> f.F11EMlCONifP�ClOq Id411AllDtIF$5 GI: /IP PI10�lE SiAiELICEN5F:1 <br /> Id[GI4NICALCORfR�CIOq A14�L40�flfcv ---�-- CIIV --�� _' ]IP ��_ �— PIIOIIf. Sf4TEUCEflSEt <br /> %/�rAL f-�l/El2G�dVSTi��'�S���L�/_Ir1--- -HYE�-1s.��.Y�W-Dnd 9P01'G 77'Y-8�/S <br /> �I.IIhIpIf1CCONiMCIOfi Id411 �DDItfcG GIY Tlr PIIONE SIAlEI.ICENSEF <br /> coemncr a�vice oF wonK <br /> --- --------"Li)F79�Gr.Sd(� j�� - <br /> �o�o. oy_ _ <br /> cescnme wonK nwo sounne rooince irivoi ern -- c�r+rnci rrnsn�nu(�riwrue No �� - <br /> xoGF-rn__,/1/ <br /> C-=.�`S �+EAZL'ai✓1/��SL�A�-�---- -- _ _—_?�-5�=8��S — _ <br /> -. I li[RESY CERTIFY iHAT I HAVF READ AND EXAMINED TlIIS <br /> vnorosro use or omim�ir, MPLICAiiON AND KNOW �FIE SAME TO BE TRUE AND CORRECT.ALI_ <br /> PfiOVI510NS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OP <br /> �ecnioescnirrio��orrnorentvisuowr�nriowonnrrna�rwocorire• WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HFREIM OR <br /> NO�. 1HF GRANTING OF A PERMIi DOES NCT PRESUME TO GIVE <br /> tot— eicx:K--- nr — ---- - -- �UTIIORITY 10 VIOLATE OR CANCEL THF PROVISIONS OF ANV <br /> 011i[fl S1A1F Ofi LOCAL iAW REGULATING CONSTRUCTION OR THE <br /> - ----' --�-� - � ���-�"---"- - �-�--� �FFlFORM�NCE OP CONSTRUCTION.THqT :AM AUTHORI2ED BY TI1E <br /> OWNFfI OP TIIIS PROPERIY TO PERFORM TfIE WORK (OR WIIICH i <br /> -� --- - �PPLICA710N IS MADE AND I C061PLY WITH TH[ STATE � <br /> rnnce�inx i n Nwnnen COIJiR11C1�ORS LAW 1827 RCW�ND 295.200 WAC. I <br /> _�ia9os-3 - Os�- O�--_---- ' <br /> cousinucTien io,v�i ennen,nvnnFsa in n•i ione r+u�aorn <br /> -- ---�- - x--�""-'----- ----- a�/��---- <br /> PROJECT ADDRESS '"�""�^" Oa�/�/_ neie <br /> d�/lo "l� s. .� cirvuu;rvr�;ticcuv.uo - -- <br /> PLUMBING MECHANICAL <br /> NO. 'fYPE OF FIXTURE OR ITEM FEE IdO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(IOILET) � NC-NI INDLG UNITS-H.P � <br /> BATHTUB ' __L FORGED NIl SYSTEMS-B.T.U. M E.A. ~ <br /> LAVATORY�WASHBASIN) � UNIiHEAIERS-B.T.U. M i <br /> — —'— ------ — ------�--�- ----��- -�-------- <br /> SHOWER __ _ i _ _ _ CLOTIIES DFlYERS _ _ � <br /> KITCHEN SINK 8 DISP ; VEM-ILATION FAN i <br /> — - DISHWASHER --�- --�-----� -- ---�-�- -RANGE HOOD -T-- <br /> — ' <br /> LAUNDFlY 7RAY ; WA1 Efl HEAIER ' _ <br /> CLOThIES WASHER �r f � �WOOD SIOVE � <br /> - -- - ---- --�- <br /> URW�L ' METAL FIREPLP.CE(WOOD BURNING) ' <br /> —L_ " _ <br /> DRINKING FOUNTAW I FIREPLACE INSERT � <br /> _ ______-Y__ _'__ ��r� <br /> � iientrutiir� � <br /> FLOOR DRAIN ____`_ _ _ <br /> BACKfLOW PREVENiERS ; 02 G�5 PIPING ' <br /> ROOP DRAINS-RAINLEAOEFiS r EXHAUST FAN —�_ <br /> SINK(SERVICE-BAFi.ETC.) —'- _ T <br /> — --- — i— ---- - — — i <br /> i <br /> — —_—' -- '___ __ ' —r <br /> _ _ — _ i — <br /> —'_—L_"_ ___— .___— — <br /> I _ _ _ "____— � � <br /> i � <br /> ___"— �—_. —___ .._--__'"_—__—.__—_ T— <br /> _� _ I 1 <br /> SUB TOTAL $ ; SUB TOTAL $ %f ; <br /> -- --------- <br /> FERMIT S � PEFlMIT $ /S � <br /> -- -___— ._..------ - — <br /> --- ------------ l�OIALPE[--5 - --- 70TALFEE $ /��'— <br /> �OR OFFICE US� ONLY: <br /> ff1O1lLSFifl�CH f1FAfiSflpGf'K SIpF`flP�f,K �IdNf:11FfKIIIRARI�.� ffP �[CFIPt1lO <br /> � ��i <br /> � - <br /> usFzone io�nnrn vnrnmsne FEE� VALUA710N FEE <br /> —r <br />� I I yES I I MO nU�Loulc � <br /> —_— _—_ ._____ _ --_- <br /> rvrrnrcnusi r�o orsmnirs ��or,.�,�. �.� r,•:����v�,��o��� . . _ . _. . -- ----. _. .----- -- <br /> �� <br /> °��,� ri ur.inwr, ; <br /> ------ -- --- ------ <br /> --- ----- - --- — ---�; <br /> s�zeoroioc Finrsrniurci.cn,nm�o onseireur MEciinrncnl __ Or�_ <br /> I1 YES I I NO -- .-. ._--.. --- ---- ---- <br /> --- A�DI�IONALPLANCHECK � <br /> xcurnNr,v�onn rinrninnr.�nron -nricmur.vrnrmri ' <br /> --�— <br /> - -- i <br /> � OIIIF.fI � <br /> —. _— __--- _— _ _-__--_ ._-_— _ -_ ----T— <br /> ncnrou <br /> srnrr:nuaniNc sur+cr�nnce � <br /> ,—_ <br /> IIlIANF OY �'L�N,nrrnovr n m CI1Y OF EVERETT ruoi.ic wo�ks ; <br /> LOCAL SALES , <br /> r,,,,,� TAX CODE IS 3105 iOTAL � <br /> I ----- --- — j , <br /> . ,w�..,� <br />