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APPLICATIG.J FOR CONSTRUCTION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASC PRINT 04L <br /> BUILDING DEPARTMENT [ HEATING SYSTEM: GAS U ELECTRIC <br /> 259.8010 <br /> 1 1 DEMOLITION I I COMBINATION ,BUILDING ( 1 MCCHANICAL I I PLUMBING I I SIGN <br /> OWNEN MAIL ADORCGs Cm ZIP PNONt - <br /> TFNA41 .��411� 1— 15 Eft (� 3• C ACL l� u�p �PCOI 1D4 4�:�3�3 <br /> iFNANr MAIL AODnESs CITY ZIP 1'11C1NE <br /> ARCHITF01 ON Vt SIUNER MAIL AUUN SS CITY ZIP rIIONF <br /> f 'G .202` IIJn�AUGNE #3G2 F',�lle��U�• ClQ.�C } A4r-) <br /> OIENCT1AL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATF IICtNSEI__ <br /> roe{ I ►nes 14 lQ I 2 RC 1 jpgq X323 Ccs nor-Z IUm S <br /> MFCHANIUAU ONIDAC'.lR MAIL AUUntSS CITY ZIP rHONF EIRE LICCNSF9 <br /> PLUMBWU CONTRACT(LR MAIL ADDIIESS CITY ZIP YHONC_ GIAIt_LC C)SFA <br /> DI890'WDnK <br /> I ;NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVF/FRPL INSERT I I BUILDING RELOCATION <br /> a33 TLN�-,-CMN, '^/� /-�/-� C ACTPERGONANOPII F.NO <br /> CONTRACT PHICk OF WOnK •� II_qI IU':>'lil/ _C�1IC'6''LS <br /> DCSCRYIF WORK ANUSUUAn!FOOTAGC IWOIVF(I 1 ' <br /> Or <br /> j.0_CM5trucfibn z5c)s �e IE <br /> Y,'OYU:.ED use or Du mNn 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> YYL L. cz dCI1C c- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LE�iIIIr110NOr PROPFRTY( WND )POUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GCVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LDrJ -, DLocK of NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMC TO GIVE <br /> IAUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Y I , ... .�•� I I �C.LYIC�S OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUC1lON. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> -Plann U�I F) CONTRACTORS LAW 10.27 RCW AND 208.200 WAC. <br /> lll"1 1 LL ,1(� <br /> LlaZcl m S T S1cLl _ x <br /> PNWLCI AODRCSS <br /> CIIYYIAIVIA[ N0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> _3WATER CLOSET (TOILET) A/C,VHNDLG UNITS—H.P, —;— <br /> Z BATHTUB ' FORCED AIR SYSTEMS-B.1,U. M E.A. I <br /> .S LAVATORY(WASH BASIN) - l; UNIT HEATERS-B.T.U. M _ <br /> SHOWER ' _ I CLOTHES DRYERS <br /> KITCHEN SINK&DISP _ ; I VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ �— <br /> LAUNDRYIFIAY WATER HEATER <br /> CLOTHES WASHER _ WOOD STOVE <br /> URINAL METAL FIREPLACE S CHIMNCY <br /> DRINKIN_G FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRANK _ HEAT PUMP _ _ • <br /> _BACKFLOW PREVENTERS _ GAS PIPING <br /> ROOF DRAINS-RAINLEADF.RS I A. <br /> EXHAUST FAN -r <br /> SINK(SERVICE-BAR,ETC.) ' _7 <br /> _. -I Lip <br /> I <br /> T— <br /> SUB TOTAL S SUB TOTAL $ -- <br /> PERMIT S — PERMIT $ <br /> TOTAL FEE S ' TOTALFEE $ 1 <br /> POR OFFICE USE ONLY: <br /> 'nONTSPTRACK RCAllSLTRACX 90C LGTFAC9 PLAN Cl ICCK NUMBER PEE qk CFIYl NO. <br /> ISk iyt��/ LO ANSA VACANT SITE FEES VALUATION FEE <br /> K'S _ <br /> 6 <br /> /4 zv rl5 BUILDING I 7+ 7 <br /> ,,1 <br /> Yrt OU WKTF.Al I OWAILL I YPC Or CnNsnl AL1UAL GC4Wxt, Kn V.ARUAEVN111 -- - - <br /> -��- - <br /> /6) �AtAn7 I PLUMBING <br /> UEOPOIIIO NO.OC RIFS DASEMFNT I <br /> MECHANICAL <br /> �tCUP/jrYL/O,AU/ fIRC LPgHKI Fq6 RE0U HEK:I I'T IVWI�p10N ADDITIONAL,PLAN CHECK 1 <br /> zb / <br /> SPRINKLER �l — <br /> kASONP RBPRWMFRB <br /> STATE BUILDING SURCHARGE <br /> ITAKF BY rLANS APPAOVF1 Y CITY OF EVERETT PURI IO WORKS .— <br /> LOCAL SALES <br /> TAX CODE IS 3105 ICTAL <br />