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FROM:EVERETT BUILDING DEPT TO ' <br /> 20664334'7:1 1,v 171 1992 2�13PM q4±R2 P.22 <br /> APPLICATION FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT r HEATING SYSTEM: ! cns U ELEOTRIC _ <br /> 259.8010 -- <br /> I I DEMOLITION I I COMBINATION XBUILDING IIMECHANICAL I <br /> O (PLUMBING I I SIGNOWNER MAR AooRCBs C" ZIP <br /> PHONE <br /> F'o.FrJT i /ioi� l�/7 `aoo_ da!(�vice 9�oc7 <br /> iFNAHi MAR ADDOCSS CITY <br /> z!r PHONE <br /> ARLHIiFGI UN DtSIDNER MWI AUUH[SG CITY <br /> 21r PIIONF <br /> $1.COWRA TC �7? �I_S a— <br /> OCNCTUL CONTRACTOO R MAR ADDRCGG CITY <br /> �J{-,/J/ •�;� ( IIP PHONE SiATF I IC[NSCI "— <br /> MFCHA41UµCONTRACTOR MAX AUURESs <br /> CITY 21P PHONE GIME LICCNGF I <br /> PLUMUINC CONTRACTOR MAR AUDR[99 CITY 21P <br /> PNONC STATE LICENSE( <br /> ZS(x WORK <br /> Ew I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FF.PL INSERT I I BUILCINO RELOCATION <br /> CONTACT PERUON ANO PNONF NO. <br /> OO'1TRAC1YWORN <N,/ <br /> OCSr.RIBF WORKORK AN OO <br /> U 90UARC ITnOCIANN VFU /-Y <br /> .• w• - 'L,.i�S V ✓O _ <br /> gni rLcSyy-h =t> t 7,7 <br /> INu uem VSEammnlNO I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> _��1NA/ C l GL APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> LELULUk INrHuNnrvRcoiary lG LnI BELr»Y un Attnce FOUR COPE 61) PROVISIONS OF LAWS ANU ORDINANCES OOVERNINO THIS TYPE OF <br /> LOT. , SLOCK OF �/JZtxLGr /IrW A/ WORK WILL BE COMPLETED WITH WHET-..'ER SPECIcIED HEREIN OR <br /> NOT. THE--� <br /> AUTHORITY TO VI OLATE OR CANCEL THE PROVISIONS OF ANY <br /> •- i.�<.l .S ��7 ✓ �- OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> -7'7< OWNER OF THIS PPOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 ROW AND 286.200 WAC. <br /> FNUJEL'I FDDRCSi X J �Z-�•��'L�Y�ft�� / r' �� 'f��� <br /> GIYNAIMI Ni! <br /> W 3 _c11Y YLLIW/K\HfINF(NO —• .-- <br /> PLUMBING MECHANICAL — <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) 1 A1C--.AMNOLG UNITS-H.P. - <br /> ^ BATHTUB I ' <br /> FORCED AIR SYSTEMS-B.T.U. M E.A. _ <br /> 5 LAVATORY(WASH BASIN) I UNIT HEATERS-B.T.U. M <br /> % - <br /> SHOWER ' CLOTHES DRYERS '— <br /> KITCHEN SINK& D 1 <br /> _ _ 1 VENTILATION FAN <br /> DISHWASHER 1 RANGE HOOD — —�— <br /> LAUNDRY TPAY 1 ' <br /> 1 WATER HEATER_ <br /> I CLOTHES WASHEq - --? WOOD STOVE -L— <br /> URINAI. —• ' <br /> _ METAL FIREPLACE 6 CHIMNGV / <br /> FL. RNG FOUNTAIN FIREPLACE_INSERT 1 <br /> HEAT PUMP BACKFLOW PREVENTERS I GAS PIPING <br /> ROOF DRAINS-RAINLEADERS .�_. <br /> -- ' EXHAU6T FAN <br /> SINK(SEFVICE-BAR,ETC.) <br /> - ' 1 <br /> _ SUB TOTAL S ' SUB TOTAL S 1 <br /> PERMIT $ ' - /C/O TOO <br /> PERMIT $ <br /> ; <br /> TOTAL FEE S ' TOTAL FEE S 1 <br /> FOR OFFICE USE ONLY: <br /> •BONY SrTRALIC � RCARSGTRACJf/ S!OC CGT4Af,K / rLA4 ClICCKNUMBER ICC_ ALCEI 1 <br /> 25 7. �_ � 117p <br /> nttLwe '� 101Anuh VACANT SRC FEES VALUATION FEE <br /> BUILDINGrfI CI CONI[.AIION'gl! IYfC OT CRNSt.ACIIIq mc~, Inq UwL UNIII c 1 <br /> PLulAowc <br /> 15`f��Sl- + NO.f)r SiONIF CASEMENT <br /> lo'l MF.CIIANICI.L ' <br /> GCUPANCY LOAU rI CSCPNXI FRG REOV ICIORT LIM!TA79N ADDITIONAI.PLAN CHECK <br /> _ I <br /> E FOR GCPINNIFR6 - 8PRINKLER / RGE <br /> STATE BUILDING SURCHARGE <br /> (SAKE BY riul:AovaovcP CY CITY 01 EVERETT PUBLIC 1 <br /> J LOCAL SALE6 wonXs 1 C/KD <br /> 2/ L y y TAX CODE IS 3105 TOTAL <br />