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APPLICATIC`N FOR CONSTRUCZ�DN PERMIT � <br /> Tp 8E COMPLETED IN BLACK INK-I�LEASE PRINT <br /> HEATING SYSTEM: G GAS U ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8870 <br /> � DEMOUTION � 1 COMBINATION i I BUILDING IIMECHANICAL �(PLUMBING I 1 SIGN <br /> ��'�� ��41LADUL�/ �� C]Y . 21P PHONE �� <br /> � ��a,"� �7�23 <br /> TENRNT M�'�RE a�/� CITY 21P PNONE <br /> 4�I�1�SIGNE���III RE55 � 21P PHONE <br /> N 2�L 1f�1��?iP <br /> GENERII�_- q� ,,,,, ,�� li�� ZIP PMOr1E STATE LICENSE� <br /> p �,..,�..D 1aG 7�9 - 9i9/ <br /> D ;�+iC <br /> MEGH�NIGQCONTFAGTOR MA�LRODNE55 CI1Y 21P PNOME STATELIGENSE� <br /> DM M�iRIICtOR� M�R/�(1DR� �� � I Y � �ZiP �— �I�7 � ST�T�E�L�/,R <br /> M�n <br /> i i �� <br /> CONTRRCT PRiCE OF M�ORK <br /> DESCF9E WORK AND SOUIRE FOOT�GE MJOlVEO CONTAGT PERSON RND PNONE NO. <br /> o �ri �s <br /> i HEREBV CERTIFY THAT 1 HAVE READ AND EX1IMINED THIS <br /> cnoroseo use a eunomc APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEWLDESCFIPiqNOFPROPERTY�SNOMMBELOWORRTT�GHTWOGOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A ?ERMIi DOES NOT PRESUME TO GIVE <br /> �oi e�ceK or AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTFUC?ION OR TNE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTFiORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE STA7E <br /> rnacei.*na i o r+uMeeA CONiRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTPUCTION IO�N LENpEN.rU0RE55.TELEPHONE NUMBFR I A �I � �- t� l �—K�� <br /> I ���� ��~� <br /> PROJE DRE C/J��_� sroH�iunr o�it <br /> ��/ /� �� � �L^r- C�ivflUMIf55:K.f�ISFNO <br /> ��� MECMAHICAL <br /> ►p, TYPE OF FlI(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRVERS ' <br /> � KITCHEN SINK�BI�P �� VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV � ; WATER HEATER ' <br /> � CLOTHES WASHER 'J WOOD STOVE � <br /> URINAL METAL FIREPLACF(WOOD BURNING) ' <br /> DRINKING FOUNTA�N � FIREPLACE INSERT __T <br /> FLOOR DHAIN HEAT PUMP <br /> BACKFLOW PREVENTEHS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � <br /> G�/IVK� MN/r,f <br /> L C� . D�f I 'e� � <br /> SUB TOTAL S ;O SUB TOTAL S �— <br /> PERMIT S �� PERMIT S <br /> TOTAL FEE S 'OO TOTAL FEE $ � <br /> FOR OFFlCE USF ONIY: <br /> fROMiSETBACN REARSETBRCK SIOESE7BACK PI.�NCMECKHU�ArpE� fEE �[GEInlI10 <br /> �J� <br /> use za+=_ LOT pRE� V�CANT SRE FEES VALUATION FEE <br /> �J YES r7 NO BUILDING <br /> -i-�orcmrns� NoorsroAies a��m��c. .oao.rt«��u��,s — �— <br /> �^�° PLUMBING i <br /> SRE O�BLOG FIfiE SPPINNLERS REdU B�SEMENT MECHANICAL <br /> fl YES f� NO — — <br /> OCGJP�N4Y LO�D PIRE�L�RM REO�O N[HiHT�IMITRTION ADDITIONAL PLAN CHECK — i <br /> i <br /> OTHER � <br /> __—� <br /> RERSON <br /> STA7E BU�I�ING SURCHARGE <br /> ni���e er— rw�Ns�rrnoven ev CITY OP EVERETT PUALIC WORKS <br /> IOCAI SIILES <br /> �q,E TAX CODE IS 3105 TOT�� <br />