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� <br /> APPfl.iCAYiL_J FC2�d ��6vi�TR�i�7°. .�� ��RMi11' �� , <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � � <br /> �HEATING SYST�M: ��J GAS ❑ELECTRIC �J __.--__-- _1 <br /> E�UILDI�G DEPAR fMENT <br /> 259-8810 <br /> �'-DEMOLITION ! COMBINATION BUILDING i ! MECHANICAL ' ' PLUMdING SIGN <br /> LIiY ZIP PIIO4E � ( <br /> D�'.r !t t.1AILA0DHE5S /�. � � ,V�1 �/!t � lG. �_� <br /> �� JOS � 4 0 �• �C �' � r <br /> _���-�/ � � <br /> i ) � � �- � T r <br /> '+cia�ur r.��i�el "W�� �� _cnr na e " - <br /> '` ��K6 /� <br /> l,9CHiTECTOR�ESIGNER IA LADGRE55 QiY ZIV PHCl�E <br /> 13�H _ ��i� Z�p PHON[ SiAi[UCENSE u <br /> GEVEFALCONTRACTOR IdAILF00RESS <br /> ��� <br /> ��x �dECHA6iCAL CGIiHAfTOP NRILA�DRESS C�iY Zlv FNONE tiiATE LICENSE M <br /> C: H _ <br /> 'b y� CiiY ZIP PHON[ STATE LICENSE< <br /> Hrxa� I'LU1.IB�NGCONTRlCTOB IdAILAD�RE55 <br /> y ZH <br /> M' y� CONiRACT PPIGE OF WOfiK <br /> '��1 H"�+] co�irncrFEas::�+nr�oP��or+Er+o <br /> �/1H GESCFIBEWORKANDSOUAREPOC'RAGE,.YOLVED <br /> ti ���;, �7�--- <br /> `H. ytl \���10 ��y1 !'7l"!-�'vl �S 902_ <br /> H �g i HEF.EBV CERTIFY THAT I HAVE READ AND EXAMINED THIS �� <br /> �" � NaoPoseouseuFeuamNc APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT.ALL <br /> �i ^ ! � PROVI�IONS OF L.AWS ANO OROINANCES GOVERNING THIS TYPE OF <br /> � 3F ` 1 �� <br /> Z iecaioescaiano�uoFaaoaearv�sNowuee�owonnrmcNn•�ocor,<, WORK YJILL BE COMPL[TED WITH WNETHER SPECIFIED HEREIN OR <br /> H y __ NOT. iHF GRANiING OF A PEFMIT DOES PIqT PRESUME TO GIVE <br /> y ��r BIOCN — OF q�,;7HORITV �O VIOLATE OR CANCEL TH'c PROVISIONS OF ANY <br /> I-i .,�f � ,� OThIER STA'i E CR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n d�^y ��'�' ���f� `� -- PERFORIAANCE OF CONSTRUCTION.THAT I AIA AUTHORIZED BY THE <br /> � � [�r OVJNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � � APPLICATION IS MADE AND i C01.1PLV WITH THE STATE <br /> 7 y(O - <br /> y p ti rnHce�tax i o.r+umeEa CONTRACiORS LAW 18.2?RCY!AND 296200 VJAC. . <br /> - \ <br /> CqHSTRUC I 11LOANIEf�'�[R �UJGE55 tELEPNON"eNNAB[r'� � ' ^ )�� � <br /> 1P y / r/ �) __ � � <br /> // /c� / __ _ . X_ _. . _l.�__ •�.._._. 1:4'C � <br /> PF70 TP�OR SS , � -.__._-__. -_�_ __---_ —_ <br /> , ,� '�.� 1 �L'�"-C - C tC:L" _ <br /> "'�'� PWMBWG � MECHANICAI <br /> � ^�+� N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �` VlATER CLOSET�TOILETI - -__- -_-_ —_--_—_ —_ „G �A H�dDIG UNITS-H P. - � <br /> _i POHGED AIF SVST[615-B.T.U. M E.A. <br /> BATHTUB � <br /> LAVATORV(WASH�BASIN) _ _ _ UNR HEATERS-B?.LL A4 ^_ <br /> SHOWER _ CLOTHESDRVERS <br /> 'w v _ _ VENTIIATION FAN <br /> KITCHEN SINK 8 DISP �'— <br /> �'� DISHWASHER RANGE HOOD __ <br /> LAUNDRY TPAY ' WATER HEATER _ <br /> �� CLOTHES WASHER <br /> -;— WOOD STOVE <br /> '�,i URINAL _ _ _METAL FlREPLACE(WOOD BURNWG) <br /> DRINKING POUNTNN _ FIPCFu10E INSERT �_ <br /> FLOOFi DRAIN ' _ HEAT PUA!P <br /> ��'� B4CKFLONJ PREV[NTERS __ __ � GAS PIPING _ <br /> ROOF ORAINS-RAINLEA�ERS T- EXH�UST FAN <br /> �� _ <br /> SINK(SERVICE-BAR,ETC.) - <br /> 1� � --- -- _ ; <br /> - - _ --------r--- - <br /> ��.. _ �, _ sua rorn� s __ <br /> _' I _ _ SUB TOTAL 5 pERMIT 5 .,, <br /> —i—__— — <br /> PERMIT S __.— — <br /> . TOTAL F6E S TOTAL FEG S —� <br /> � FOR OFFICE USE ONLY: <br /> — <iDESFiIiACK �LnnC��i'Ckl��RA�ER �IL ��ECF.iVTNJ <br /> FROIlTSEiOACK RURS@TDALH ,.�f�'�l'/ � <br /> a <br /> us�-zor�e io�nr+En vncu+rsire FEES VALUATION FEE <br /> NO.OFSiORIES r`�'� YES I NO pUIL�MG � � <br /> __ "—'. . .. ...-- _"_�— I <br /> Pif40lCON5i. clo6v[ MO�PIr�u•:�.�^�ds ---_.----_ - <br /> �r�;+ pLUM�ING ' <br /> _ — � <br /> — —' 1 <br /> g)�:pFOLOG. FIR[SPBINNLERSRW'U DASEIdENi h1ECHANIC�L _ �, <br /> I - YES ' ' NO —— — -----— <br /> AD:�ITIONAL PLAN CHLCK � <br /> OLC�IPANCYLOAO FIRLALARtdREO'D I HEiGHTLIMIiATIOtI __ ' <br /> OTH�P � <br /> ____'_' _._—__— ___—_---�. <br /> ��erson <br /> STATL E3UILDING S'JRCHANGE <br /> —_ —_"— <br /> _._ __ '_.---"'""__— _— _—_ i <br /> _' ._..____..._ __..._.— <br /> �cr�«E o� i��aNsnrvnoveo nv CITY OF EVERETT ����•ouc�:�u�iKs � <br /> LOCAL SALES -- -�— 1 <br /> o�tr TAX CODE IS 3105 TOTAL <br />