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FRG,h:EVERETT BUILDING DEPT TO: 206643:1475 SRN 171 1992 2:13PM 8412 P.02 <br /> AIPPLICATIk,N FOR CONSTRUC'► .ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMEt I' HEATING SYSTEM: GAS U ELECTRIC <br /> 259.8810 �J <br /> I I DEMOLITION I I COMBINATION f BUILDING 11 MECHANICAL _ <br /> OWNER BUILDING N 1 , I I HA I I PLUMBING 11 SIGN <br /> I I.,j.CI.AtkL'W L OW7 <br /> PHONE " <br /> MAR ADDRCCS cn•r �f4 a a 3 <br /> ZP PHORE �'�• <br /> ARC•IHHtFC10MUklIONZO (� MAIL AUUMESS <br /> 130 AV 7 !3a 3[J CITY ZIP P110WA, <br /> OlHCMILONTR(ACyTOyq�11�•I'y� MAR ADCFS <br /> ZIP <br /> =.•`, ILl I1��7 IY'"EIO I " /TTY PHON! <br /> ��� Q[� ` gTATFIK:[NlCI <br /> IAFCNA4NALQITnACTnR MAAAIpinC33 CITYZIM •-__ � •�a�_�GKLnrr2IOTY1]' <br /> PMONC tlTATI LKCNgF IT <br /> PLUMtlINU COHTMLTM MAR AUDIIl39 _ <br /> CITY 21P pnDNC <br /> g i Al[LICCNpF I <br /> f.LAgg fX YIOOK .. - <br /> NEW I I ADDITION I I ALTERATION rI I REPAIR I I DEMOLLI�TfOc PEfl60NWNDO STTOO�FRPI INSERT I I BUILDING RELOCATION <br /> CANTRAGI pHICk DF Y/0=kpi-•I�.c�15�58.(,J© A <br /> D.RtlIF WO}C ANDSOU P�T MVI l315. 4�r -12-_3 r .. — <br /> pN MUtlEO USC Of fl11AMN0 •_ <br /> HAWE <br /> �nt•LL APPL CATION ANDIKNOW THEISAME TO BETRUE ANO CORRECT.ALL <br /> LEGAL Ukg HON PRMFA, •N DELCM One,•.AcI'FOURDOPIEg7 - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LOTBLOCK OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 1 + NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ha- <br /> �cuCIBT �{ I I( I t lCfl �Lt(YA�A AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �{� _ OTHER STATE OR LOCAL LAW REGULI'TING CONSTRUCTION OR THE <br /> A" I;JOUQ�CJ 1 ^1 PERFORMANCE OF CONSTRUCTION.TI-AT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERcORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND E9C.200 WAC. <br /> a53I+ x .leue� P.F 2'2 q2 <br /> PNWLL`I ADO [Ag <br /> PLUMBING No <br /> �---"— <br /> NO• TYPE OF FIXTURE OR ITEM MECHANICAL <br /> FEE N0. TYPE OF EQUIPMENT <br /> 'NATER CLOSET ITOILET) FEE <br /> _ _ IVC-•-AAiNDLG UNITS-M.P. <br /> .'� BATHTUB <br /> LAVATORY IASH BASIN) L FORCED AIR SSTEMS—B <br /> .T.U._ M E.A. <br /> HOWER UNIT HEATERS— .LU. M _ T <br /> ' _ CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP I VENTILATION FAN <br /> DISHWASHER - I <br /> LAUNDRYTRAY —�-- <br /> _ CLOTHES WASHER —' ��— .- WATER HEATER 1 <br /> _ URINAL ' WOOD STOVE •-F— <br /> DRINKING FOUNTAIN - METAL FIREPLACE 8 CHIMNEY OF <br /> ,I FIREPLACE INSERT <br /> FLOOR DRAIN I HEAT PUMP ••• ' <br /> _BACKFLOW PREVENTERS _ ( GAS PIPING <br /> ROOF DRAINS-RAINLEADERS ' <br /> EXHAUST FAfSERVIC_E-BAR,ETC.) —'- I - 1 <br /> I ' <br /> SUB <br /> 1 <br /> PER TOTAL S I SUBTOTAL $ <br /> _ PERMIT 6 <br /> $ <br /> TOTAL FEE S ' TOTAL FEE <br /> FOR OFFICE USE ONLY: <br /> 'rloNrpPrRALK OCARgCTpgfX SIOLOCTOACR <br /> z7 j, _• �vv n I rCIICLKNIIMBFR MCC '` y RECEIPT In <br /> L011! <br /> �6lc� toT AnkA Vl (! • ohP eel 3� V � _ <br /> BgZ J / VACANT 417E FEES <br /> _ VALUATION FEE <br /> Fri Of CONTC.MIOWAILL TTNDI CONST ACTUAL BUILDING <br /> %N OCCUMxr wI VH1LILILLIANL . .... _ _ 1 <br /> LAPP <br /> 3 I PLUMBING <br /> Opf ' <br /> 17b1 Sf NO.00 KansccNr <br /> TORIFS <br /> uMECHANICAL <br /> K:CIHMNC:YLLO <br /> AG _ <br /> NCOAR AD rinC gpRNKl FR6 REOU HENNITLMYTATION AODITIONAI.PLAN CHECK <br /> 7 ' <br /> hASON F00 BrpMKIFRg SPRINKLER ((( t'r� _— /0 I�U <br /> STATE 13UILOING SURCHARGE I <br /> /FAKV BY rUWLAPPROVFLl9Y CITY OF EVEBETI -"" _• 'SU <br /> LOCAL SALES Pu9ucwoRKe <br /> J}� 3 TAX CODE IS 3105 TOTAL <br />