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ApPLiCAT1C �1 �OR CUWSTRIi�T �N PE��iIIIT �✓� I <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING GEPARTMENT �GATING SYSTcM: JGAS y�ELECTRIC J _.___..__ _. � <br /> 259�BB10 <br /> DEMOLtTION COMBINATION _ BUILDING MECHANICAL PLUMBING SIGN <br /> owNFr. MAn aoouL�� nrv n� rrronr <br /> L�'Lf e ,BLffNi(' .E. cXo?,�� �vP1��—�_�'�D,3 ✓'Q� -3Ss�1�'..S <br /> TEH,�q i M�ILApONE55 CIiY 71C PIIONE <br /> �!'��,,v f.�i��.r�cv_,ry ��/�- _p��cJ_ aa�b - �7s��srPd� — <br /> nncN�*�_crnaoesinv + u.i�aooAess �� CITv I�P PIION[ <br /> �1� /� s'!tl/v�r — -- <br /> GCNFRAICONiRACTOR M�IIRDDRE55 CiTv IIP PIqNE SiAiELIGENSE� <br /> MECH�NiC�L GONTN�CTOF NMl ADDRE55 GTV 21P PMONE SUTE IICENSf� <br /> PWMBINOCONTq�CTOR N��I�D�AE55 GTY ZIP PHONE STA'EUCENSFI <br /> CONTR4f.T PRiCE Of WORh <br /> UESCRI�RD S��E FOOu F�F V� — CONi PE)150V�NPI'l10 �� ��� /l ?��� -�� <br /> !i �G �� <br /> ,�l�u� �"07l3.�'. <br /> � --- ------------- - --- -- --- <br /> KlAJ1.C___/ '�'�_---. i HEREl1V CERTIPV THAT I HAVE R[AD AND EXAMINED TH S <br /> PROPOSEDUSE OF BOILDINO APPLICATION AND HNOW THE SAME TO BL TRUE AND CURR[CT.A.L <br /> PFOVISIONS OF LAWS ANU ORDINi,NCES GGVERNING THIS TYPE(�F <br /> IEG�I.DESCFiPT10NOFPROPERfViSNOWNpfIOWOPpiTpCNTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPFCIFIED HEfiEW C�R <br /> NOi THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI�'E <br /> LOT / — A1O0K °° --� AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> —lj _q��-r" `� � �,-9�___,__ OTh:�R STAfE OR LOCAL LAW REGULATING CONSTRUCTION OR TF�E <br /> y'� / PERFORMAPICE OF CONSTqUCTION. THAT I AM AU7HORI2ED�V THE <br /> � er, �'•J�G �Gf�,/� OVJNEF OF '�HIS PROPEflTV TO PERFURM TNE WORK FOR WHICII <br /> ✓� APPLICATIOM IS MADE AND I COMPLY WITH THE STATE <br /> P�PGEL T�N I D AUMBER CONTRACT �5 LAW 1827 RCW AND 29fi200 WAC. <br /> CONSTRUCTIONIO�NIEN�ER \OURE55.TELEPHONENUMBER � / O//O/�� <br /> _ C ��—� O <br /> PR JECT ADDRESS � �, ' .' ,"' � —J�1��y,f� � � "„` --� <br /> 2� — r n�.s�asx,�ri..�:�i. — �y...._`__ _ — <br /> PLUMBING ECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A'C—A�HNDLG UNITS—H.P <br /> BATHlUB FORCEDAIRSVSTEMS—BTU M EA. <br /> LAVATORY(WASH BASIN) —� UNIT HEATERS—B.TU. M <br /> SHOWER / CLOTHES�fiVERS <br /> KITCHfN SINK 8 DISP VENTILATION f�AN <br /> DISHWASHER 1 RANGE HOOD <br /> ' LAUNDRY TRAV ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL. METAL FIFiEPLACE(WOOD BURNING) <br /> DRINKIVG FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFI.OW PREVENTERS GAS PIPIfJG <br /> ROOF DRAI�dS—RAINLEADERS EXHAUST FAN _ <br /> SINK�SERVICE—BAR,ETC.) <br /> SUB TOTAI S SUB TOTAL E • '; <br /> PERMIT 5 r PEFMIT E ____ <br /> T()TAL FEE $ TOTAL FEE E <br /> FOR OFFICE USE ONLY: <br /> FRONi5F1A�CK qE�FSFiBACK 51t)F.SEiB 'N PI�NCIFI.nNU1,lOF9 fEl � AFCF��i � <br /> �v' S� 2 `3C' "� ��s`5��7 <br /> use zo� �oT�ae�q veenr+r srte FEE VALUATION FEE <br /> 2_� �V� /'�VES N� PUILDING �(y 3�j • -�� ' �/� /J��// <br /> fvPE�OylGONSI IqOF5TORIES acve•nr+ h�a�mvn��W��ex•rs — -�' --� - -- <br /> _ ,y —N I -°"� ' PI.UMBING -_ /. J - <br /> rs � <br /> 512EOFBlOQF Y, �i�F5P91NNLEP5RE0'0 BAiEMENi � � MECHANICAI. <br /> IJZJ J � �. YES �✓NO -- --- . �'1 <br /> 44o S� Gv�2 /1�J — � <br /> OGCUP�NCV h40 FiqE IUNM RE00 NEIGHT llMitATiON� AODITIONAL PLAN CHECK � <br /> N I/4 N'v ��v� OTMER _ _ ��� ' <br /> RF�SON <br /> STATE BUIl01NG SURqNARtiE ��� <br /> INi�NE BV PlPNS APf�IOV-0PV CITY OF EVERETT PUBLIC WORNS �(�� �� <br /> IOCAL SALES <br /> oR,F `3 . TAX CODE IS 3105 *oT�� �•(��j ;!j(? <br />