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APPLICATIC _J FOR CONSTRUC'� _ Jld PERWIIT ���� <br /> TO BE COMPLETED IN BI.ACK INK—PLEASE PRIN7 <br /> � HEATING SYSTEM: ;20 GAS U ELECTRIC C] —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION COMBINATION � BUILDING *:MECHANICAL !'PLUMBING SIGN <br /> OWNER ' M� �DORE55 GLV ZIP PNONE <br /> SI�r-,�/n��luS�Ee ��us,: /�/1.�,�x3�/D� ��E,�rr ��'Ic�� 3���' - ;539 <br /> �tNANi AI�IL�O�RE55 LIIV IIP PHONE <br /> �RCMrtEC70R0E5iGNER MAiLAD�RE55 CRv 2iP oqONE <br /> �R(JI �eS�U � �FeEr - - - - .3�/1-�'9��/ <br /> C.EN Al CONTRACTOR M�II���NE55 diV 21P PIIO E STATE UCENSE• <br /> ��Q`�911isr��c,tisr ��1 Qnx 3���� �J�ll>> '��-'b'�!`���'tt'1u• 'licct� <br /> 4ECH�NN.Q CdITP�C OR I.UIL�DOtiE55 Gi ZIP � VIIONE SiRE UCENSE• <br /> lin�Ar�n �aTl�1a, �//f.�"� _ ?�.?i-�S�,�S <br /> PLUM ING CONiRACTOR M41L�PORE55 Cit'• zIP PHONE ST�TE IICENSG� <br /> ��v �I�, � �-v r�Q P�, �'y� �. ', _ 9,Q�S� 7y�-cii3 <br /> CL�SS OF WOAN <br /> X NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FFPL INSERT BUILDING RELOC4TION <br /> CC T�Ci PEPSON ANO P/qNE NO <br /> CONTR�Ci PHIGE UF WONN .'��� � � j��. — 7 �Q�/� <br /> I ` � <br /> �ESCRIBF.WORN�ND SWARE FOOi�GC INVOLVEO <br /> �-VFw-�--�,.��1/,T�1 ��A'b - � � � <br /> PROPOSEDUSEOFBWIDING i HEREBV CERTIFV THAT I HAVE READ AN'� EXAMINED THIS <br /> ��� APPLICA?:�iJ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> IEG�L0E5CRIPTIONOFPROPiRTY�SNOWNBELOWON�TTA�H[p�JRCOPIs� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISiVPEOP <br /> c7 � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior 'L e�ocK or NOT. THE GRANTING OF A PERMIT OOES NO7 PRESUME TO GIVE <br /> 3��94� � AUTHORITV TO VIi,LATE OR CANCEL THE PROVISIONS OF ANY <br /> �(=_ !c^�'Q/it.ke ��L1FJG%L!`�'O OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> PERFORMANCE OF CONSTAUCTION.THAT I AM AU7HOFIZED BV THE <br /> OWNER 0� THIS PROPERTV 7U PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITFI THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC <br /> x � �i_.. �— Z_�-9.5— <br /> PRQIECTADDRE55 sicn nnt oe'f <br /> 2� l� / t (nv �Sr�ISSUfINSfNC1 <br /> PLUMBINO MECHANICAL <br /> NO. TVPE OF FI%TURE OH ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> ,3 WATER CLOSET�TOILET) / A'C—A�HNOIG UNITS—H.P. <br /> � BATHTUB � FORCED AIR SVSTEHS—B.T.LL M E.A. <br /> LAVATORV(WASH BASIN) / UNIT HEATERS—OS U. M <br /> �. SHON'EF CLOiHESDRVERS -' <br /> KIl�'HEN SINK 8 DISP VENTILATION FAN � <br /> DISHWA'HER � I RANGE HOOD � <br /> LAUNDRV :RAV � WATER HEATER — ' <br /> CLO7HES WASHER / WOODSiOVE � <br /> URINAL METAL FIFEPLACE 8 CHiMNEY <br /> DRINHING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOfi DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUS7 FAN <br /> SINK(SERVICE—BAR,ETQ) <br /> � <br /> SUB TOTAL $ SUB TOTAL E � <br /> PERMIT $ ' PER�11T S � <br /> TOTAL FEE $ � TOTAL FEE $ _ <br /> FOR OFFICE USE ONLY: � <br /> FRONTSEiBACK RE�NSETB�CN SIOESETBACR � PUNCNECNNUMB R FCE �� RELEIPfNO � <br /> 7� � /O � �O � � <br /> use m. �otnaen wc�Ntsrte FEES VALUATION FEE <br /> ' gt �z3 �i'.�2_ �70 <br /> BUILDING <br /> lYMO�GONiS�IIOW�BIE iYPE01CON51ALIU�I IXCo��S�+ MOqpwluiNsu4'�5 <br /> ^Tr /J � I �°�' I PLUMDING _ i <br /> L / <br /> SIIE OF BIDG NO OF STORIES BASEAIEN� MECHANICAL <br /> 7l�i <br /> /S52 S/` C��wG <br /> D <br /> • SOS Sf (�RA� Z ADDITIONALPIANCFIECK �— <br /> OCGUP�NGY LO�^O FIRE 3PRNNlERS REOD N�}I '�li IMItARIN <br /> N �'! !/�J ' SPFINKLER —' <br /> RE�SON F09 SPRiNNlEFS — <br /> STATE BUILOING SUHCHAHGE �� <br /> IN*�KE Bv PUNS�PPROyED q. CITY OF EVERETT PUBLIC WORK$ L(/ � � <br /> �,J Id" LOCAL SALES <br /> ��5�y� TAXCOOEIS3105 rorn� _ •'�i� j��; <br />