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APPLICATIOID FOR CONSTRUCTION PERMIT <br />10 ❑E COMPI. ETED IN BLACK INK -PLEASE PRINT^> <br />BUILDING DEPARTMENT <br />HLATItV; 5r31I M J GAS J I Li GIHIG Q_ <br />- - ---- <br />258.8810 <br />I I DEMOLITION i COMBINATION BUILDING I IMECHANICAL I IPLUMBING I I SIGN <br />IMIIII YAA mmi rry nnXK �AI <br />FP ere l�ndusitaaL e °�D �1LCo. I`I y 15_d 4C�k �'x . Bothell, �bP 9Bo// <br />ILMANI WlAd4E6 1.m IA• R10A <br />So�{tuorld S+•SLID_ ���tii-------- <br />ArIC1Y1l C1 fN plSgNIP Wl A[IIVN uE GIY <br />11I M,P``r.G��NIP61(MI WI AINIPl E5 411 lll' NCX! SlArf IfINSEI <br />A�M�LGIIS SD 9- I +—N uAA CITY cr�__q osa r��)B83-oayl <br />wuuNKx aullPAclg1 Alnpss urr try +IDrK rnR lcunt, <br />NkKc i7j, ft. a'15(n3 s7�c TAIM 311 NSQkTN'lal�3 dN� <br />nMnAquXnn•crI wA Nnln rs uIr rA• n. rA suR lKtrls[A <br />DEVA"Wf11M AM150.MPIlQIIYIf NYdMn�Fire <br />fFMIAGi nNA]N ANDRIYMR Iq— � <br />adds(� (I31 1�Cafes �Ioo_���r <br />�� <br />—��01��311pH' I Ulan,"19(, <br />a p1-d—VISI0V1. Z 15goo <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PPL1rVN (I'm IX PwADNII <br />I•el- _ <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />tt"lKr<PmlgNv nra•[Prr ingPnnllw Ml AtIAGl TYIa flwts, <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRICTION OR THE <br />---'--- -- -- - - - '--- - - -- ' - -- - - <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />------- -- - <br />APPLICATION IS MADF AND i COMPLY WITH THE STATE <br />P. IpAA nNAwnn��A,t��,s/LL//L, <br />3_SN.�SLY-. ... __. <br />CONTRACT RS LAW I8SI RCW AND 29a200 WAC <br />uwvmA:IPw IaArl ILMtn. A(ID11fR 1FLEM"01 MANII II <br />- <br />e II-aI-9s <br />x� � <br />PROJECT ADDRESS -- <br />1, <br />5-I" .S. W. <br />-- — -- <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO, <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET ITOILETI <br />BATHTUp <br />_T <br />- <br />AC-NHNDLG UNITS-H P. <br />FORCED AIR SYSTEMS-6 TU. M E.A. <br />_ <br />LAVATORY (WASH BASINI <br />UNIT HEATERS-BSU M <br />SHOWER <br />KITCHEN SINK A DISP <br />DISHWASHER ---- --- - <br />CLOTHESURYERS <br />—_- <br />-- <br />VENTILATION FAN <br />_--- — <br />RANGE HOOD <br />HEATER <br />_ <br />LAUNDRY TRAY <br />_ _ <br />�~ <br />_ <br />_ <br />_ <br />CLOTHESWASHER <br />URINAL _ <br />DRINKING FOUNTAIN <br />TLOOR DRAIN --- — <br />_W_ATEH <br />WOOD STOVE <br />_ <br />ME TAL FIREPLACE IWOO_O BUflNING1 <br />_ <br />FIREPLACE INSERT <br />-_----_ <br />-- <br />IIF,AT PUMP <br />_ <br />GAS PIPING <br />_ _ <br />PNEVkNTLNS <br />_ <br />I, XHAUST FAN <br />_-- - --- <br />_ <br />_OACKFLOW <br />ROOFDMINS-RAINLEADI NS <br />' <br />!tINKISEflVICE- OAR,FTCI <br />SUB TOTAL_ S <br />SUBTOTAL S <br />_ <br />PERMIT f <br />Puma S <br />_ <br />TOTAL FEE II <br />_ <br />TdiA_L_FEI7 S <br />FOR OFFICE USE <br />ONLY: <br />.M.1 !.I IIW• <br />111'All l'.IIMIJ. <br />wI, LTWA <br />I NI I w11:A lAlYN11 <br />t' 0 4N <br />11! <br />INCIIPI MI <br />mirylrn <br />_ <br />�oI AMA ---�— <br />XAr.ANI&n. <br />FEES <br />VALUATION <br />FEE <br />_--_ <br />Lnu uwsi � <br />�.uu7ne <br />YES NO <br />nn.w. AV NrwII4. .. <br />nD ui <br />_ <br />6V1M Ina <br />BAMwNI <br />Ip SI•IIMlllllSgan <br />III I:IIAIn(nl <br />I I YES f I NO <br />- ---- <br />.ADINIKAiA11", Al. I;HECK <br />rXGIM1A;r11WI <br />rp AIAPY WOn <br />wAWILW1AtgN <br />�i <br />T-'LG <br />'.rAtE BUILUIN..:WNCIMfIDE <br />II[ASP1 <br />NEW Kr - nn CITY OF EVERETT <br />wmUr, WLMns <br />' <br />' <br />LOCAL SALES <br />FmK7.1 <br />TOTAL <br />�� <br />L `I i TAX CODE IS 3105 <br />