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FROMIEVERETT BUILDING DEPT TO: 2066433475 TAN 171 1992 2:13PM 9412 P.02 <br /> e'o'APPLICATION FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT 04L <br /> X135-ovv-o�5-000v <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS Lj ELECTRIC <br /> 259.0810 <br /> 1 1 DEMOLITION I I COMBINATION BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br /> ONN$A AU2 AD DRIERS CRY 21P iHONF <br /> iFNANi MNL ADDnCSG CITY 2P PIIONE <br /> ARC�NITFCI ON UCSIUh'CO MAIL AUUHESS CI,Y LIP MIoNF <br /> —Lf�nrj %,�— ' uA/ /� .l' WL ! L/'5 7.L ✓Cn <br /> OCNCRAL CONTRACTOR MAM1 ADDRCSG CITY 2P PHONE STATF I ICENSEF <br /> tcO QTIO �GcJJZL/— ,— u . arae <br /> NFCHAHIUAL CON7MClOq MAA AUURESS C:TV 21r PMDNG SIATE LICCNSFI <br /> PLVMe:N000HTR/.CTO4 MAIL ADDRCSS CITY ZIP rMONC ­F1, LICCNSFI —•- <br /> CI A63 Ur WOnK <br /> KNEW I I ADDITION I I ALTERATION I I REPAIR 11 DEMOLITION_ I I WOODSTOVE/FRPL INSERT I I DUILOING RELOCATION i <br /> CONTACT PER60NA1)DPIION N0. <br /> C4HTRACT PHICk UFWOnK - /-7 L+ OC�. L10 Dan/GSCOM IRK�IRKANUSOU``A�TI�CCrOOTA/PqC�INV(AVFI1 <br /> �C�T.ri7-lcL�"F1y72 3� J Y r�/ � - <br /> PNXrDCEDusEorDllnnlNn n I HEREBY CERTIFY THAT I HAVE READ NO EXAMINED THIS <br /> L<1U e APPLCATION AND KNOW THE SAME TO BE TRUE AND COARECT.ALL <br /> LEaAI 4tCIIIP ION orogOPFRTYIG OWN BELOW OnApTTACNFCVR'COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOT '7�•_. eLIDCK _ of l�LLCJ� )rZe/I WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> .... GL CSL<�G�LJ /� ✓ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION CR THE <br /> -7` Ll <br /> ^ PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZEDWORK <br /> OR BY THE <br /> �1 ✓ OWNER OF THIS PROPERTY TO PERFORM THE WORK FDR WHICH <br /> APPLICATION IS A? <br /> CONTRACTORS LAW 18.2D7ERCW AND 08.00 WAC.AND I COMPLY WITH THE STATE <br /> CONTR <br /> /7 <br /> PMIJkCI ADDRCSS •— GKIKAIVeS NTf <br /> g3 w,.ST ✓ F_ ye ti-z It 9 ` ,?d3 <br /> — <br /> alnlnwrAKNFru••u0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET)..- 1 AJC•-A/HNDLG UNITS—H.P. <br /> BATHYUB FORCED AIR SYSTEMS—D.T.U. ME.A. _ 1 <br /> —� (WAH BA <br /> LAVATORYSSIVj i UNIT HEATERS—B,T.U. M <br /> �(_ SHOWER I CLOTHES DRYERS <br /> _ KITCHEN SINK B DISP _ i VENTILATION FAN <br /> DISHWASHER 1 I RANGE HOOD _ �— <br /> LAUNDRY TRAY ; _ WATER HEATER <br /> CLOTHES WASHER _ — - WOOD STOVE <br /> URINAI. _ ! METAL FIREPLACE ECHIMNEY —~ <br /> DRINKIN_G FOUNTAIN I FIREPLACE INSERT -_ '-- <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOWPREVENTERS I GAS PIPING <br /> ROOF DRAINS—RAINLEADERS 1 EKHAUST FAN •�— <br /> SINK(SERVICE—BAR,ETC.) <br /> 1 <br /> 1 <br /> 1 <br /> SUBTOTA'. S �I _ SUBTOTAL S <br /> PER $ <br /> _ PERMIT _ $ <br /> TOTAL FEE $ <br /> I TOTAL FEE $ 1 <br /> FOR OFFICE USE ONLY: <br /> RICNTSrTAACK OCAR SGTRACK SIOC GGIMACK f PLAN CIICCK HIIMBGR ECC / RFCk INO. <br /> f A5 <br /> SSL EUNC LO,AMkA VACANI SITE FEES VALUATION FEE <br /> -s_ _ 116 e.3 / <br /> BUILDING ZC7 Y'tS !Q 72 1 <br /> Trta[OnIF uIDNAIIf 1Tr(DI CONBLCIINI fKCVMK+ Kn eT RAT111KC VInI —• �•�� � -� ! — <br /> S0EOF DLTO NO.WSTOAI 6DASGN Nr <br /> 32MECHANICAL <br /> / fCt?2 <br /> Y-CUPANCY LOAD r1nC SPnHKI FqB REOU I HErIIi LINITATION ADDITIONAL PLAN CIICCK I <br /> r� Z <br /> to NF�SPNNKI F R6 <br /> A,' <br /> 6PRP:KLEA <br /> STATE BUILDING SURCHARGE <br /> JKE BY PLNIS APPROVFhUY CITY OF EVERETT PUBLIC WORKS I <br /> J I� LOCAL SALES <br /> Z//Y z qZ/- TAX CODE IS 3105 TOTAL of Ij <br /> t <br />