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APPLICATIC"'1 FOR CONSTRUCT�-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> — — - - ---- — — <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS �ELECTRIC J ____ _ <br /> � <br /> 259-8810 <br /> DEMOLITION COMBINATION ?C BUILDING MECHANICAL PLUMBING SIGN <br /> OWNCR MIIl�U0RFS5 Lilv ZIP PH@IE <br /> ►11�cL,c1c vrl,Lew2c,2x� 3Y� -705`� <br /> 1FNnNi N�ILAppq[55 (;Ii1' 7iP P�iONE <br /> ��.5 �o� L�_Pl.�ke 5,�. F�,�7T 1�1g33�zOfs <br /> �RfHrtECTOHDESiCNER M�il�Of�RF55 CiiY li� � PIIOVF <br /> OENER�ICONiR�CTOR I,IAIL�OORE55 CITV IIP PNONE SL�TELiL(NSE• <br /> 1L1.S.S. CoN�rk►.1,.�'T�CaN r'�S 71naQ ST�5��vS�1}�L4t9_`'-�fJ_2oi �.53-f'fS0 <br /> MECNRNICALf.ONiH�CiOR M�IL�DOAEFS CI1Y Zi� Pi�ONE �� $iAtEI�CE�E1�^� <br /> /�/i.Y.�k Q <br /> �{/ T'n V V <br /> PIUMOINGCONTNACTOR M�IIADORE55 CiiY IiP PHONE S7�tELICENSE• <br /> C(XliR�CT PR�CE OF WpjN <br /> o`1D.0�jp,"� <br /> OESLRIPE ORN qND SOWRE FOO7RGE INVOIVED GONMCT PERSON RNO PMONE NO <br /> AUD yySssF rv B�oF H <br /> i HEREBV CERTIFV THAT I HAVE REAO AND EXAMINED THIS <br /> Pao o use ov uaoirvcn� � APPLICATION AND KNOW THE SAME 10 BE TRUE AND CORRECT. ALL <br /> �A�1��1 KCS�I� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �ecn�oescnivTron f R(N'ER7Y�SNOWNBELOWOR�TT�CHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �o*- nioc� or pUTHORITV TO VIOLATE OR CANCEL THE PHOVISIONS OF ANV <br /> � ���� •�OG./;n��/'y,^� OTHER STATE OF LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> -�'���d-��d PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> '� � OWNEP OF THIS PROPERTY TO PE.iFORM THE WORK FOR WHICH <br /> � � � � �1�,�• ��x'�' J APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> i� P�RCEI T1M I D NUMBER ����� CONTRACTOR LAW 18. 7 RCW AND 296200 WAC j <br /> : r . <br /> ' GONSiPUCTIONLO�NLENOEA ��ORE55TElEPHfX1ENUAIBER � <br /> �vOrlE 3fi7/� <br /> ' PNOJECT ADDRESS ♦� W sK�nunr � �u e.��, rore <br /> 3Z P v� LRvpl�fi4fSSVftNaM <br /> PLUMBINO MECHANICAL <br />� NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET�TOILET) NC-A�HNDLG UNITg-H.P. <br /> i BATHTUB FORCED AIR SVSTEMS-B T.U. M E.A. � <br /> � IAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> SHOWER CLOTHESDRVERS -r <br /> KITCHEN SINK 8 DISP I VENTILAl10N FAN � <br /> DISHWASHER � RANGE HOOD <br /> � LAUNDFVTRAV ; WATER HEATER <br /> ` �, , CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> j DRINKING FOUNTAIN ; FIREPLACE INSERT <br /> ' FLOOR DRAIN HEAT PUMP <br /> � , BACKFLOW PREVENTERS GAS PIPING <br /> '� ��, ROOF DRAINS-RAINLEADEHS EXHAUST FAN <br /> I�i; � ' � _ SINK(SERVICE-BAR,ETC.) <br /> �- <br /> SU8 TOTAL S SUB TOTAL S <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONISE�K, RE�RSEIP�CM SIDESELBRCN/ PUNC��fCNNUAIPEl1 FEE �/O �iFf,EiPINI)�� <br /> S �� 9 <br /> usezone wt�nen wcervrsire FEES VALUATION FEE <br /> � I - VES INO -T <br /> BUIIDING (J�J <br /> IVaE 01 LONSf NO Ov STORIES tr[cowr� im ni•w;r,i H,irv��x — ��) • •� � �— <br /> �' p'.3 � PLUMBING —_ <br /> 1` <br /> SRE O�9LbG FIRE SPRINNLERS REOD HnSEMENt MECHANICAL <br /> y� 5� �J VES NO �-- <br /> OCCUP�NCVlOAO FiRE�L�RpIRF.OD HEIOHTLIMrt�tiON ADDITIONALPLANCHECK a <br /> ���� �Q I <br /> N�/� __/.y= /1�._. OTHER � <br /> PE�SON —__"—_ —__�_ " - <br /> STAtE BUILUWG SURCHARGE ; /�� <br /> _"_— —'_'__... __ --. .. __. . . _. _—.__ — <br /> ►1 <br /> iN�RKE�Pv PIANS�PQR VE06v CITY OF EVERETT PUBLIC WORNS --�� <br /> J LOCALSALES <br /> n.rF L c� TAX CODE IS 3105 rora �7�Q ; D <br />