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�— <br /> ��5� APPL.IC,A'P'10�1 �OR CONSTRUCTLON pE1�M1Y �/���' <br /> TO BE COMPLETED IN BLACK INK—PLEA3E PRINT �\�n' <br /> [�7 � � BUILDIPIG DEPARTMENT HEATWG SYSTEM: ' GAS ❑ELECTRIC !J 1 <br /> +p � x 259-8810 <br /> y y y DEMOLITION COMBINATION ;(BUIL�IING MECHANICAL PLUMBING SIGN <br /> t� <br /> H � O:INER MAllAODP[55 S4�ri C CIiY ZIP FHONE <br /> F] H I.�.�L��T C.10N1N 1135•E. �VL�LTTMALLwnY E�c�ic�i' 95�zoY 3$�J'�5/'V <br /> � �—] � i[N4NT h1ARA00RE5S CITY Z�.f PHONE <br /> oxo <br /> �'�J H "+] ___ <br /> V� Ht+ A�+CNItECTORO[SIGNER MAIIA�DRESS CITV ZiP YHGN[ <br /> Cao �1 f3��� Gqu6FF2riN ��iSN $0�4ST, SLA7TLL� �..A �8��3 5:�7- �a5� — <br /> y � ('.F.NFFALCONTRACTOF MAiLAD�FE55 ��LL�� C Cli" ZIP PHpN[ SiATELICENS@r <br /> C.�oNiti nav�Es � �3 sc �v�zciT YNhLL 'uA� �vc.zcT' '�6�5 3S3-Lsvo �',CoNtf/T/��/IiT � <br /> H [�iJ g MECHANICALCONTRACTOR IdAIL��DRE55 GITY ZIP PHUNE STAT[LIGENSEa <br /> (7 Y (555] <br /> �i y S PWl.IBWGCONiRACTOR M, i�DDRE55 Clii ZIP PNONE yiATELI.:ENS[k <br /> 9 [sf <br /> r� z <br /> �y~ y CLASSOFYlORN <br /> O � � �JEW ADDITION � ALTERATION REPAIR DEMCLITION , WOODSTOVE/FRPL WSERT BUII DING RELOCATION <br /> �f� /.3 � 7 CONTACi PERSON AND PNONE NO <br /> � � � CONTRACTPRIGEOFWORR � 17—C� ,Oop,OU �31LLLyNLUS �53—�i}�Cl <br /> ZHCn ❑ESCRIOEWJRKANDSOl1AREFOOTAGEINVOLVEU <br /> � H O v. 2913 q.1 NEw S F.R- <br /> HaoroseouseoFew�owc i HEREBY CERTIFV THAT I HAVE READ AND EXAMINe[7 THIS <br /> S.F.i1. APPLICATION AND KNOW ,.1E SAME TO PE TRUE AND CORPECT.ALL <br /> iecn�oescaianonoFaaoPearviseow�r+oeio�r�anrrncHFouacoaiesl PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot ��J BLOCK oF NOT. THE GRANTIMG OF A PERMIT COES NOT PRESUME TO GIVE <br /> ,/ AUTHORITY TO VIOLATE OR CANCEL THE PRQVISIONS OF ANY <br /> l0�q'rA/N V/Lw .(� S OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OA THE <br /> PFRFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFlIZED BY THE <br /> OWNER OF THIS FROPEFTV TO PERFORM THE WCH!: FOR WHICH <br /> APPLICATION IS MADE AND I C01.1PLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � Y I g i u �� ��. 5.6. EvEaErr- �� �.,t�� y��/�z <br /> PRGJECTADDRE55 y.,!.mune� p:r: �— <br /> �.� ����J <br /> ��� ci*r u�.�.t+:rss uc[ruE mo <br /> PLUMBING MEC4ANICAL <br /> ,�t NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) /S' �— AiC—A�HNDLG UNITS—HP _ <br /> ��� 2— BATHTUB �r / FORCED AIR SYSTE�dS—B.T.LL M E.A. <br /> � ' ' 5 LAVATORV(N.'ASH BAiIN) UNIT HEATEP.S—B.T.L'. M <br /> � � SHOWER — CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP �- VE�ITILATIOIv FAN <br /> ' E ' / DISHW��SHER {' �— / qANGEHOOD _ <br /> i LAU�DRY TRAY � ; — / WATER HEATER <br /> •.�I CLOTHES WASHER $ — WOODSTOVE <br /> � URINAL / METAL FIREPLACE 8 CHIMNEY :30 ; — <br /> ' ORINKING FOUNTAIN FIREPLACE INSERT <br /> 1� FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTER� GAS PIPIIJG <br /> �1 ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> 'e . <br /> ..../ :✓� 10:. .f'F � � <br /> � <br /> 0 <br /> ' '� _ — <br /> SUBTOTAL S S ; SUBTOTAL 5 U I <br /> � PERMIT 5 PERMIT 5 <br /> TOTAL�EE S T9TALFEE S <br /> FOR OFFICE USE OtdLY: Sa y y� �c <br /> �RONtSETBACK REAlISE'BACK SDESETB�CK PlfdiCH[Ctt��u!'.O[!i FEE RECEIPiNO <br /> zEs � zy ' S ' ." ;�:;_=, `502-/2 � � <br /> usez ne �oraaen vncnNrsiTe FEES VALUATION FEE <br /> �/ BUIIDING �'j8�PA3 '7?G IOc <br /> 11PE0FGONiSALl�WABLE tYPE0FC01151.ALNfI Occu�aptr xaorp�iipicw.ns — — i <br /> caou3 / pLUh101NG 7� �U o <br /> '1 — <br /> 92EOFyiDG. NO.OFSTORIES BTSEIdEIJT MECHFNICAL <br /> 2851 sr� //O 'aU <br /> �i3 Sr ea J � <br /> OCCtIPANGYLOAD FiRESPRNNLERSREOD HEiG,.H�TLpIMIiATiON ADOITIONA:PLANCHEfK y� i��� <br /> N� �A SPRINHIER <br /> RF.ASON FOR SPRINHIERS — <br /> STATE�UILOING SURCHARGE c/ � r� <br /> __�i <br /> imnK�ev a�nr�snranoveo ov CITY OF EVERETT PUBUC WORHs � <br /> LOCAL SALES �U ' G`� <br /> _j�} � a/,� TAX CODE IS 3105 TOTAL �57 � �� <br />