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_T - _ T� _ - <br /> APPLICATI�*'�l FOR CONSTRUCT�4Ni PERMIT �✓?� <br /> TO BE CO�NPLETED IN BLACK INK—PLEASE PRIN f <br /> 9UILDING DEPARTMENT HEATING SY�TEM: ' GAS ❑ ELECTRIC ❑ <br /> 259-8810 —� <br /> C7 DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> �pWrNER MAILADDflESS CpITY ���/// !� ZIGP J� �7 PHONE/' <br /> -�1 � I�li/YI(.) I��AIIAIDY��3�Q - JF. Nw� �%��IOVI!/ rH�L.Scl�� <br /> TENANT —� <br /> SKuTr�YEs'\/�� I��JUSI�[Gf��C/� �i�{ G�� ZIPI�V ��� �/�OE�L�IC�AENSEa <br /> GENEflALCONTRACTOq MAILpODRE55 <br /> /� �CU � '�'FS �ll�yh'�..�i�7+�w� <br /> MECHANICFLCOVTRACiOF MAILA�DRESS CITV ZIP PHONE STATEIICENSEn <br /> PIUMBINGCONTRAGiOF MNLAODRESS CITY ZIP PHONE STATELICENSEq <br /> CONTHACT PRICE OF WORK <br /> DEnCF18E,y'OR�AS$O11A17 T�GEnIN/Vv ly I -�/ , ' Rc . CONiACTPER50NANDPHONENO. <br /> 7 I,�J�'VNf � .,� 1 /1�/�i��'v f'z�P/ `��1�� S <br /> c ? ��$ Li v; 5� ct / �ld <br /> - ' � � � .-- Q��/�� - I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> BPOS oFa oin�---- " APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> '_ 5��� �l PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn �ESCRIPTION PROPERTv'SHOWN�ELOWORATTACHTR'OCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGFI�D HEREIN OR <br /> 1 �� NOT. 1"HE GRANTING OF A PERMIT DOES NOT PRcSUME TO GIVE � <br /> LOT BLOCK-- pF � <br /> ' hUTHORITY TO VIOLATE OR CANCEL THE PROVISIOIJS Of ANY <br /> O'HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />� PARCELTAXI.O.NUMBER APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />� CONTRACTOAS LAW 18.27 RCW AND 296.200 WAC. , <br /> CONSTRUCTIONLOANLLNDEF.ADDRESS,TELEPHONENUMBER �� , <br /> .�v'�' ��-�y y <br /> - � PFOJECT 7ADDR°S{SI ,/ �i �� si NAipRE o��E 7 <br /> 7` ` � I I GiTpU5111E$$IICEN5EN0 <br /> . PWMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE � <br /> WATER CLOSET(TOILET) A/C—AfHNDLG UNITS—H.P. ; <br /> ' BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E..4. -�—�—�— <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS --r— <br /> KITCHEN SINK&DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WA�HER � WOOD STOVE ; <br /> URINAL � METAL FIREPLACE(WOOD BUR�lING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP --�— <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF URP.INS—HAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � <br /> -- i <br /> i i <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> _ P[RMIT S PER'v11T 5 ; <br /> TOTAL FEE $ - TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FFONTSETDACK REaRSETBACN SIDESETD�CK PIANCH�!'M� _ FEE������ REGEIPTII��� <br /> (/ <br /> usezoNe �oTaeen vncnwrsrtF FEES � VALUATION FEE <br /> I J YES U NO g��ILDING I�Z � ,�p ----���' - <br /> � <br /> ivPEoftarl5i. NOAPSroqIES e[Grar.cr unoroNuuncu':n5 <br /> • �— GP[.P I � / i <br /> PLUMBWG � i <br /> ♦ � <br /> 512EOF�LDG. FIRESPRINKLERSBEO'D BAoEMENT MECHANICAL ��Oi <br /> 3(D j �UD ❑ YES �NO <br /> � <br /> OGCUPoINC'fLOnD FlfiEnlnRldREO'D HEIGHTLILIITnT10N AODITIONALPLANCHECK i <br /> Y�� ---� <br /> PEASON OTHER � j /�/��i � <br /> /yN �1,n, G(J <br /> �N/IAJHIVG� S7A7E BUILDING SURCHAFiGE <br /> ' � \ <br /> 14iAKFpY PLANSAPPFOVED�Y CITY OP EVERETT PUBLIC WORKS � <br /> �� LOCAL SALES — <br /> o�Te 2 U� TAX CODE IS 3105 TOTAL �� l ; �-- , <br /> . �-CJ ,JC <br />