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�C"FRa <br /> APPLICATIC� FO� CONSTRUC7'�"JN PERMIT � � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � � BUILDING DEPARTMENT HEATING SYS7cM: ❑GAS ❑ELECTRIC Q_. —� ' <br /> p�� , , 259-6810 <br /> y - '�DEMOUTION i COM6INATION BUILDING MEtiHANICAL PLUMBING SIGN � <br /> OWNER MAILA�ORE55 ITV ZIP PHONE <br /> ���(((]]] .�1�I oh,�i�7�,�3o Z �r y� A-�,7 .v.� �,,a.27v.���= r,c��9. 9szzd <br /> �f]� � T���/ MAI�pDDRE55 CIT'I 21P PNONE � <br /> �� � Y�Y-ac�� � <br /> CA r1RCHITECTOq�E51GNER MAILAD�RESS CItV ZIP PHCNE <br /> ��^i <br /> `L� GENERAILONTpAGTOR MAILADDRESS CITV ZIP PHOIIE STATELICENSE• , <br /> r� �� q <br /> �y �N!/fJ�'L/2 <br /> � '�7C MECHANICALCONTRACTOR Mr11LA��qESS CIiY ZiP PHONE STAiELICENSEv I <br /> �Iy � I <br /> 'I.y� PLOMBINGCONiFACTOR MAILAODRESS CIiY ZIP PHONE STATELIGENS[/ <br /> r <br /> M CLASS OF WORK � <br /> ��y �_I NEW i i ADDITION I '� ALTERATION REFAIR � � DEMOLITION ��, WOOCSTOVE/FRPL INSERT BUILDING FELOCATION �, <br /> �y CONiAC7 PERSON AllD PNONE Np. r <br /> `y� CONTRACT PRICE OF WOflK <br /> Oy OESCRIBE WORK ANO SOIIAHE F00TAGE INVOWED I <br /> � aacaoseouseoFew�oiHc I HEREBY CFflTIFY THAT I HAVE READ AIdD EXAMINED THIS I <br /> . APPLICATION AND HNOVJ THE SAME TO BE TRUE AND CORRECT.ALL � <br /> LEGR� JzSCRIPiIONOFPqOPEFTY�SNOWNBEI.OWORATTACHF011I1C0?IES� PROVISIONS OF LAWS AND ORDINANCES GOVEPNING THIS TYPE OF + <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEFlEIN OR { <br /> �or BIOCK oF NOT. THE GRANTING OF A PERMIT DOES N0T PRESi1ME TO GIVE �, <br /> AUiHORITY TO VIOL�TE OR CANCEL THE PROVISIONS OF ANY <br /> , �7 J . / "�/T�t O/D OOO. OTHER STATE OR LCCAL LAW P.EGULATING CONSTRUCTION OFl THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I�M AUTHORIZED BV ThIE <br /> OWNER OF THIS FROPERTY 70 PERFORM THE WORK FOR WHICH <br /> — APPLiCATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTHACTO 5 LAW 18.27 RCW AND 29 200 WAC. <br /> C-J/ „/ <br /> (� 1 �/�� �` /' <br /> '�__�� �/ 1L/T._J./—. X �� � _Gc,cc�,,,r ����Z- . <br /> PROJECTAOpRE55• � /A (� s uune onre <br /> I1 //U/ �G(l��( �J/�l ��Vc7 CRYOtISi•�F55l:Cf.3Ei:p � <br /> PLUMBING MECHANICAL - <br /> ' ' NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> _ WATER CLOSET(TOILET) NC—NH�DLG UNITS—H.P. � <br /> 0�' BATHTUB i FORCEDAIRSYSTEMS—b.T.U. M E.A --~-- <br /> 1 ' LAVATORV(WASH BASiN) � UNIT HEATERS—B.T.U. M �— <br /> � SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&OISP VENTILATION FF,N <br /> ' DISHWASHER RANGE HOOD <br /> ' LAUNDRV TRAY _ ; WqTF.R HEATER _ <br /> CLOTHES WhSHER i WOODSTOVE <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> 'w DRI�JKIN(i FOUNTAIN FIREPLACE INSERT <br /> '� FLOOR DRAIi! HEAT PUMP <br /> �� BACKFLOW PREVENTERS � GAS PIPING <br /> ROOF ORAINS—RAINLEADERS � <br /> w EXHAUSTFAN <br /> ' SINK(S�RVICE—BAR,FT0.) -� <br /> �' � <br /> � <br /> � <br /> '_' �— <br /> ' SUB TOTAL $ ' SU�TOTAL 5 <br /> PERMIT $ PERMIT 5 <br /> ��--�� TOTAL FEE 5 T07AL FEE $ --�— <br /> FOR OFFICE USE ONLY: <br /> FRONTSEtBACH PEAqSEiBACN SIDESEipACN PLANCHECKNUM1IBEB FEE dLCEIPTNO. <br /> 77,7 C <br /> usezoHe LOipRE� vacaNrsr: FEES VALUATION FEE <br /> BUILDING <br /> TYPEOFLONiS.ALlOWAOLE i1PE0FCON57ACiIlAI acu�ann HOO�Vua�.�rt;cw:ns <br /> caouv <br /> PLUMBING <br /> S2EOFB�UG. NOAFSTORIES BTSEMEN� MECHANICAL <br /> OGCl1PANCYLOAD PiFESPRNHLERSREOD MEIGHTLRAITATION AODITIONALPLFNCHcCK <br /> REASON FOR SPqINKLERS $PRINHLER i <br /> �— <br /> SiATEBUIIDINGSURCHARGE y �s� <br /> �NTAKEBY PLANSAPPROVEDBY � <br /> CITY OF EVERETT PUBLIC WORKS <br /> C�' /�L`-,j�-�' LOCAL SALES � <br /> _e=.y /h ,6...-� TAX COOE IS 3105 TOTAL y ��y <br />