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APPLICATIC 1 FOR �ONSTRUCT� 1N PEhc�v�1�� ,,,�, F <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��« <br />f HEATING SYSTEM1I� j1 GAS J ELECTRIC J <br />-/'� <br />DUILDING DEPARTMENT — - - -- -- – - <br />259-8810 <br />DEMOLITION COMBINATION �L BUILDING i MECHANICAL PLUMBING SiGtJ <br />OVMF.R A1AIL Rpb�iESS <br />�ue..� ' /y <br />1@UNL IA41L AODRE55 <br />PRCNRCLiOR�ESiGNEB M�IL�D[1RF55 <br />1��5;�,() �, C�,�,� l 9is—N <br />GFNE(i�L'CONTP�QOR �Il �D�NF55 <br />�� 1 n�Q�l� <br />NFCHRNIC l CGNLFACIOB A1411 4pDRF55 <br />RUTABINGCONTPAGJR MAIL/,OpR[SS <br />CONiP�CT PPICE O: WORK <br />�� � <br />DfSCRIBE WORNANDSOW�E FOOIPGE INVOIVE[ <br />CRV <br />nROPO5E0 USf J� BUILDiNG <br />S� <br />1 EG�L DESCRIPTpN OF PPOPERTY ISHOWN PEIO W OR Aii�CH 1 W0 CUPiE51 <br />lOT-� BIOCK - U: �/���J� <br />P�RCEi 1AN 1 � NLIMyc R <br />Pe�f�� 01� .�73� -oaG-Oy7-4oU <br />G]NSTRUCLIONLOANLENOEP ROOAESS TftEPMONENU6�B[n <br />PROJECT ADDRESS <br />�„. _..,�� c-�.c1' <br />NO. TVPE OF FI%TURE OR ITEM <br />WATER CLOSET �TOILET� <br />BATHTUB <br />Z. LAVATORYIWASH BASIN) <br />SHGWER <br />KITCHEN SINK d O�SP <br />DISHWASN�-R _ _ <br />LAUND�VTRAV <br />CLCIHES WASHER <br />UFINAL <br />DRINHING FOUNTAIN <br />FIOOR DRAIN <br />SINK (SERVICE-DAR. ETG.� <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />�RONiSCiBACK �1Fhfi5CiNACY / <br />�' � <br />utif70W l�rtP � <br />.�-/ �� / <br />IYFEO�CCN51 NOpfSIORiES <br />'�N -'-�— <br />�SIZE�O�:OLIX�i �� IiRESPRiNN,L'E^P5RE0'0 <br />47��F__Sa * � <br />(H:tUP�NGYlp4G RqE�i�RMfiEOD <br />iNf4NFHv PIANSAPPpOI�l�F3v <br />�,��� � � /� <br />FEE <br />0 <br />nr pHor+E <br />���� 3s�3-�GoG -- -- <br />Zlr PqpNE <br />—_. <br />IIP PIIONF <br />�? °3 --�r��1---. - _.__ <br />2iv rr�aNc SLr��.�-�h:[: <br />�12.1'_3��_ba�Jp/�U13*//0 � E <br />L��` PIIONE r, , ��,� i � <br />JIP ______- PH)Nk �--SIn1Eli�iN>f• <br />CONtACt PEii50N dV;l oqONE NO <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMWGf! li�i`, <br />APPLICATION AND KNOW THE iAME TO OE TRUE AND CORRE �' 1 nl I. <br />PFiOVISIONS OF LAWS AND ORC�INANCES GOVEqNING THIS 1 Yi'L OF <br />WORK WILL BE COMPLEiEO WI7H WHETHER SPECIFIED HERFIN OR <br />NOT. ?HE GPANTING OF A PERMIT DO[5 NOT PRGSUME TO GIVE <br />AUTHOPITV TO VIOLA7E OR CANCEL TH[ P9C41SIONS OF AMV <br />OTHER STA7E OR LOCAL LAW REGULATING CONS7qUCTION Ofi THF <br />PERFORMANCE OF CONSTRl1CT10N. THAT 1 AM AUTIIQR12ED PV 'HF <br />OWNER OF THIS PROPERTY TO PERFORM TNl: WORV Pni�l ;'I��i('.r-� <br />APFLICATION IS MADE AND I C06�PLv �Vifu t�il '�v�ir <br />CONTRACTORS LAN' �827 RC AND 296 200 WAC <br />�� ' � � <br />s�mu�u�a � v� <br />—.,,,, —:, , -- _ <br />MECHANICAL <br />NO. TVPE OF EOUIPMENT <br />A'C-A�HNDLG UNRS-H.P. <br />1 FORCED AIR SVSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T,U M <br />� CLOTHL.,�RYERS <br />ENTILAT104 FAN <br />� RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE IWO00 BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PiP�MG <br />'-Z E%HAUSi FAN <br />�-.inrs[ronqr � riaHu�ecxrv�naa[n <br />� �_-1� � [�� i / � � <br />wcnNti e FEES <br />YES NO 9iiI�DMG <br />no�.n ..no�C'x6r�.�,n —_.— <br />%���`� ' PLUMBIN, <br />1� <br />BaSE/AENt � � MFCHANICFL <br />V[$ ✓NO --- <br />HEiG���tn.uranoN ADDITIONALPLANCH[CK <br />7� / O'4ER_ � � �_ <br />5T4tE BUIIDING SURCHARGE <br />CITY OF EVERETT PUALIC YIORNS <br />LOCAL SALES <br />TAX CODE IS 3105 Tora� <br />z y-�y <br />FEE <br />SUBTOTAL $ _ ��' <br />PERMIT 6 <br />. TOTAL I'ICii C __.__ <br />/ <br />,— -- <br />rtlf _ _'�-� qn <br />- J � --� �1 -- ---- <br />VALUATION fEL <br />�s,z�6 _�,�'l ' �2> <br />/�, 7 <br />_ __._ __ _ .!1-�— ��. <br />_ -- iY t/ <br />_ <br />"_.. _ . . �/ �)ii <br />