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- -"` _ �.. .rv��w � ��VV � ��i�\ 1"C.i'SIYIf � �� <br />- TO BE COMPLE7E0 IN BLACK INK—PLEASE PRINT�.� �„�,, <br />"33?`7 <br />BUILDINQ DEPP�RTMENT HEATING SYSI'EM: GAS 1;;� EIECTRIC ❑ <br />259-8810 � <br />❑ DEWIOI_T10N � COMI�INATION O BUILDING �MECHANICAL ❑ PLUMBING ❑ 51GN <br />�\,,,�� �y.�� �w1.�oone�} 'd ��" � nr/ <br />IY�2.I\���'� LXVY\C'Jl 0�7 ��I%L���(�ek� 71S%�' `� �JJ"J�I� <br />F <br />wi xoca <br />�, <br />PARC6l T�VI I.D. HUMBER <br />�nucnoH w�w u� <br />SHOWEH <br />UUNDRY TRAY <br />BACKFLOW <br />[�:� <br />FOR OFFICE USE ONLY: <br />F110NTlE7MCN PSARBEiBACK <br />UBE 20NE <br />rn a wrwt. <br />INTN(E pV <br />FIRE SPRINKLERB REp'0 <br />FINE NAAM REO'D <br />o�Te <br />C�T� <br />21P PMbNE <br />jIP PMpNfi <br />"r P�NE BTATELICENBE/ <br />ZIP V110NE BTATE IICENBE / ' � <br />iiP oNONE BTATELICEN9EI <br />GONTACTPERSON <br />� <br />9- <br />i HEREBV C6RTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />ttrocon�¢sl WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE pRANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION GR THE <br />PERFORMANCE OF CUNSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br />CONTRy2�b18-t�Al� 19.27 RCW AND 288.200 WAC. <br />r <br />V�rpq•:�q�SYlr,1'NSf �R! / � <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />A/G—A/HNDLG UNITS—H,P. <br />FORCED AIF SYSTEMS—B.T.U. . M E.A. <br />U�IT HEATERS—B.T.U. M ; <br />CLOTHES DRVERS � <br />VENTIIATION FhN ' <br />RANuEH000 , <br />WATER HEATER � <br />W000 STOVE ; <br />METAL FIREPLACE (WOOD BURNINfi) � <br />FIREPLACE INSERT ' <br />HEAT PUMP i <br />GAS PIPING ' <br />EXHAUSTFAN , <br />&IOE <br />^ ves ' No eu��o�Nc <br />acw�M. xo or ownuwc uy�+s <br />aa• PLUMBwG <br />MSEMENT MECHANICAI <br />o ves o No <br />HE16HT LIMIUTION ADOITIONAL PLAIJ CHECK <br />OTHER <br />$TATE BUILDING SURCHAqGE <br />CITY OF EVERETT � PUBLIC WORN$ <br />LUCAL SALES r-- <br />TAl( CODE IS 3105 • � TOTAL <br />SUB TOTAL E <br />PERMIT $ <br />TOTAI �[c' E <br />