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APPLICATIC J FOR CONSTRUC7 _ .�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ����� <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS I�j ELECTRIC �J � <br /> 259-8810 <br /> ! I DEMOLITION COMBINATION )(BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER M�R 11D�FE55 ��Ty Zip P1qNE <br /> R. Keith Jensen 810 109th St, SE Everett 98208 206-353-0155 <br /> TEN�NT M�R�IIORESS CITV )�p p�qryE <br /> R. Keitf� Jensen 810 109th St, SE Everet,t g8208 206-353-0155 <br /> ARCHITECTOR�ESIONER MMLAfORE55 d7V 21p VNONE (Charles <br /> Home Design Services �,']tg Liberty Ave, NF. Marysville 98270 206-653-1659 �...,.,�,. <br /> aENEPiU.COHTRACTOR M�II AOORE55 CITY 21P ^11pryE STnT�N�SE�y� <br /> R. Keith Jensen 810 109th :'t, SE Everett gB208� 206-353-0155 <br /> MEGN�NI:ILLCONTR�CTOR MI1ILA�DRF.55 CITY —� ZIP �'IqNE STQEIIGENSE• <br /> PLUMBINOCp1TRACid1 M�II�DDRE55 CITV zIP P1qNE ST�iEIICENSEI <br /> CIAGSOFVARK _-- -- -- — <br /> I i NEW I X ADDITION �$ ALTERATIOCN REPAIR D�MOLITION W�)OpSTOVE/FRPL INSEFT BUILDING RELOCATION <br /> ��,(��Jf �/.�p D CONT��T VERSUN��7 PNONE N0 <br /> CONTMCTPRICEOFWOH. � �Keith Jens�n or Judy Supplee 206-353-0155 <br /> DESCRI WORR ANU RE fOOT�GE IN VED ---- <br /> , � �i.e d n �757 s-�'� �».Y' t'. . �c - <br /> Pi10POSEDUSEOFBUIlUINO I HERE V CERTIFY TFIAT 1 HAVE qEAD AND EXAMINEO THIS <br /> Rrci Aenrr_(nersonall APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRFCT.ALL <br /> �eauoese�OFPqOPEP7Y�5110YMBELOWOR�fTACHF(NIRCOPFS� PROVI310NSOFLAWSANDORDIN4NCESGWERNINGTHISTYPEOP <br /> WORK WILL B'c COMPLETED WI7H WHETHER SPECIFIED HEREIN OR <br /> �or etxK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF AN1� <br /> Rroadmay Farms No_ 7 f q OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEFFORMANCE OF CONSTRUCTION. THA7 I AM AUTHORIZED 8V THE <br /> OWNER OF 7HIS PRO�EfiTY TO PERFORM THE WORK FOR WHICH <br /> — APPLI('ATION IS M�1DE ANO 1 COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 1E.27 RCW AND 296.200 WAC. <br /> PROJECTAODPE66 pu�iva[ ��� �� p� � /��� - <br /> CrtYBUSMf45LR[NSEHO <br /> PLUMlINO MECHANICAL <br /> NO. TYPE OF fl)(TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) UNIT HEATEHS—B.T.U. M ' <br /> SHOWER CLOTHESDRVERS <br /> KITCHEN SINK 8�ISP � VENTILATION FAN <br /> OISHWASHEF � � RANGE HOOD . <br /> LAUNOHY TRAV ; WATER HEATER <br /> _ CLOTHES WASHEH WOOU STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR D�iAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF�RAINS—RAINLEADERS —� EXHAUST FAN , <br /> SINH(SERVICE—BAR,ETC.) ; <br /> --'— <br /> ` <br /> � <br /> SUB TOTAL S ;� SUB TOTAL S � <br /> PERMIT S � PERMIT E <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT6ETB�CRO� RE�RSETB�CK SIOESETB�CN PUNCHECNNUMNEH FEE��,/ Cf; RECEIPiNO�/ <br /> 2 C" 3 ° 7�CJ <br /> USEZd1E IOTARE� V�C�NTSITE FEES VALUATION FEE <br /> - ) o �8� iuc' 33'a4o 0 <br /> BUILDING � <br /> iYPE Oi fANiS�IIOWABLE tYPE Of CON57�CIVAI aCcuwMr xo a owtumauxits <br /> _ � 3 I _ PLUMBING �u �_ <br /> 81ZE OF BLDO NO OF STORIEO &15EMEN'f MECHANICAL T— <br /> �� 3U i —- <br /> OLCUP�NCV LO�U FlRE SPqNNLERS REOD NENiH7i LIMIfRION ADDITIONAL PUN CHECN ' <br /> ^�� `� SPflINKIER i <br /> NEA FORfiPRINKLERS -- — <br /> STATE BUILDING SUHCHARGE � 'J G <br /> MT�REBY PLANS.iPPPOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES ' <br /> Jl� TAI(CODE IS 3105 TOTAL � ��� , <br />