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APPLICATIC`1 FOR CONSTRUCT'1N PERMIT '�� <br /> TO BE COMPI.ETED IN BLACK INK—PLEASE PRINT <br /> - - �-- ----J <br /> BUILDING DEPARTMENT � HEATING SYSTEM: J GAS J ELECTRIC J ��/�C- <br /> 259-8810 <br /> DEMOLITION COMBINATION �(BUILDING MECHANICAL PLUMBING SIGN <br /> ------- - -- -- ------- — ---- _--- - <br /> -�lY'dn hln:l nDi�H1 S�, Oiv lN mL ryi <br /> /G�/cK {��/LA ✓� g3i�oy� y�S.c' ��_�r 9�ao� 3 ss- i �ds <br /> �!vnrU MN� nDDu�'s5 t ilv I�P r�UrvF � � <br /> S/3"i+-9 � <br /> nncNitFc,rulaUESicNFA 41nnnDrH(ti5 Ci�r :6+ -�� puoqE -- <br /> SA'c•a� <br /> G!NFRR f.JNiFnC10R I.IAi�nDORE55 CITv 71P PIIpNE STAIE UCENSE• <br /> i��[L��RNIUICONtRRCipq MAiIqpDNESS C11V ZIP PHONE ST�tELIGEN5E1 <br /> �9UMAiNGCONTR�CTOR MAIL�DDRE55 Citv IIp PIqHE STATEII'ENSE• <br /> fDNiR4f,1 vqq:F Of WORK _— <br /> C��1�� <br /> C�!tiCRi9F Ylt)RK A ID SOU4PF FppT�fE INVOIYED COhGCi FhRSON�Nu PNONE NO <br /> -- - —�D U 5'� �T <br /> �t,o��� .�� - <br /> `�— — -- <br /> - — 1 HEfiFBV CERTIFV THAi I HAVE READ AND EXAMINED THIS <br /> nnoroseo use o�nw�mNa �.�!_ APPLICATION ANO KNOW fHE SA(dE TO BE TRUE AND CORRECT.ALL <br /> � � �'�� �/v� PROVISIONS OF LAW9 AND ORDINANCES GOVERNING THIS TVPE OF <br /> ir�niDescnirrionovnnonEnrv�sr.owNne�owonnnnunwocor�rs WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> . OOOD-0/ B��OL�FY /�yliQmf NOT. THE GRANTING OF A PEfiMiT DOES NOT PRESUME TO GIVE <br /> iui-- n�cx.x -- or _N_U�s <br /> QE(r, S [�coR, t.ut 47 88 * y/0 'i T�'� �� AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> S �N Sp LOT 7.2 FT_ TN _�/ /.Z O FT TH OTHER STATE OR LOCAL LAW REGUT ATING CONSTRUCTION OR THL <br /> N�Y K '�IO�/�' w �x a r ro µ1 L N S'� PERFOR�7�NCF OF CONSTRUCTION THAT I AM AUTHORIZED BV THE <br /> T� TN S .(�_ O �� 7 PD OWNER OF THIS PROPERTV TO FERFORM THE WORN FOR WHICH <br /> r�nn:ti.rnx�onuraper� --- - APPLICATION IS MADE AND I CO�APLV WITH TNE STATE <br /> 3�70� 000`D��^D�Oy CONTRA�SLAW1827RCWAAND296200WAC <br /> CON.`+IPUCLOq�OANIEND(R n[10uF5S 1E�FCIIONFNUMOFR /pJAI n/// <br /> ��—� � � — <br /> �PR ECT ADDR SS 987-� . .� ..°� ""� -� <br /> 3/-/oQ�`^ Sf S,E. E wA. ,,,,... – - — - <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM fFE NO. TYPE OF EOUIPMENT FFE <br /> WATER CLOSET�TOILET� � A G- A HNCLG UNITS-�H.P. ' <br /> BATHTUB ' FORCED AIF SVSTEMS-B.TU. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS-B.TU. M <br /> SHOWER CLOTHES�AVEFS <br /> , KITCHEN SINN 8 DISP VEHTILATION FAN <br /> DI51{yyASHER RANGE HOOD <br /> LAUNDRV TRAV WATER HEATER <br /> CLOTHES WA.iHER WOOD 5T0\'E <br /> URINAL METAL FIREPLACE (WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> fLOOR DRAIN HEAT PUMP <br /> _ BACKFLOW PREVENTERS CAS PIPING <br /> ROOF DRAINS--RAINLEADEn E%HAUSTFAN <br /> SINK�SEflVICE-BAR.FTC.) <br /> -- — _ �__ <br /> SUB TOTAL S SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> _.._.__ —. _ _ .__.-_— �_ <br /> TOTAL FEE S ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> �Vi�ql y iFlnr.a nl nn"1 tpnf,M S��F SFiP 1M 14 nNO�pr . 1�1f1[R fFF .v RFfE�PI HO <br /> ��-- -� 5 � d-fo� — �..)�7 SJ `• < ' �.J�� <br /> ���si}one ior nnen vncnNr sne FEES VALUATION FEE <br /> I^� .�ZK � � NWLUWG _ .� _I�v___ r�fl_-' ) <br /> _ �, �t�= 4 <br /> VES N <br /> tr'�!pll0115t NOOGSiORiFS i �V . . ----.- . _.- . .--- � — � .�- <br /> riu�.�[�iNc <br /> ]�N�-- -_.l_—_ ��-1 �- - -- - <br /> sVF O�BIUf nRF SPRiNKiEli511EOD OASEMLM � � MECHANICAI. <br /> �l'�O $ r(o VES ✓NO - - --- - -- - <br /> ucr urnNrv�oeu FIRE�URP HEOD HHaHf li�AtiAnON AD'�ITIONAL PLPN CHECK <br /> � <br /> i <br /> - _ <br /> u � <br /> A z 1 oniea � <br /> - — --- -- ---- <br /> r�rnsn ---- - - --- ---- -- <br /> STATE BUILDING SURC11AR3E � ; i�� <br /> N;.;F n,— �����,.�^., „ ��. ' CITY OF EVERETT v��ei ic wor�ks -- -- -- - <br /> � LOCALSALES <br /> „�„ J 2 �, iAK COOE IS 31D5 TOTAL <br />