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APPLICATI��J FOIF� CONSTRIJCT:�N PERMIT ��� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC O _� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUi�7BING SIGN <br /> O EH IdqILADDRE55 CItY 21P PIIONE <br /> ��C�Dr„�i�.u�i�Us �Y1NK zsrZs� Cu��� �v�rr ��zor �u�- 3iy-ss:.o <br /> � e �y �ANT MAILADDRESS CITY 21 PMONE <br /> ro � '' � ��Er_ .� p-F��a.r d- �-�oPwroc:o L�zS ��-ri4 '�uv���rr �1SJ�1 2u6 � 33ti-ss.�� <br /> p � qPCNITECiOfl0E51GNER Mn: DDRE55 CITV ZiP PHONE <br /> b H N <br /> �N[RAICONRiAGTOR c MALLADDRE55 QTV IiP PNONE 2U SiRTELILENSE� <br /> K y � \,1GN5��i(.� `,PE�iALi'tES �NC ZZoi tU6ft.L� A-VE��JUY.tl5b2o� Y.a"frWb3 SSG1JSs2 1131� <br /> MBGHANIGALLONiMCTOR MAILAODRESS GTY 21P PMONE STAtEII[ENSG� <br /> 'i1 � �V <br /> N H <br /> � Q � PLUMBINGCQ4TPACiON MAILAOORESS CIIY ZIF PNONE STAL[LICENS[s <br /> la O <br /> H <br /> �,p (� d C�IA�SSOFWOflN <br /> � :ti �j ;�NE'N I ' ADDITION �. '� ALTERATION �. �. REPAIR DEMOLITIOtJ WOODSTOVE/FFiPL INSERT ' BUILDING RELOCATION <br /> Zy y � p�Jy y CO4TnACiPEii50NANDPMONENO <br /> h� Z CONiRACTPRIC[OFWORK N ✓W�•vV [f�- ��Ly. Qf- ']�t 2,�,r� ,7r,{�'�OVf� <br /> y y D CRIBEWORKANDSOl1AREi00U6E1N\DLVEO ��-j� <br /> � d �, �cc�N — —15 � <br /> � p P PJS[OUSEOFBUIL�ING i HEREBY CEFTIFV THAT 1 HAVE READ AND EXA611NED THIS <br /> y y �A'NF• APPLICATION AND KNOW THE SAME TO 6E TAUE AND COFRECL ALL <br /> y � y IEGALDESCNIPTIONOFPROPERTY�GNOWN BELOW OR4TiAGNPOURGOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �oi BIOCK �� oF i�.�,�r WORK WILL BE COMPLETED WITH WHETHEI7 SPECIPIED HEREIN OR <br /> —� ��e -�-'� NOL THE GflANTING OF A PERA9IT DOES NOT PRESIIME TO GNE <br /> � AUTHORITY TO VIOLATE GR CANCEL THE PROVISIONS OP ANY <br /> �.-�� -�G -/ >- /P �! i P /{ OTHER STATE OR LOCAL LAW REGULATING CONSTf7UCT10N OF THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E�BY TH[ <br /> OWNER OF THIS PROPERtV 70 PERFORM THE WOPK FOR VJHICH <br /> APPLICATIOPI IS 61ADE AND I COAIPLV WITH THE STA7E <br /> CONTflACTORS lAW 1A?7 RCbV AND 29fi200 WAC. <br /> x/�w�/2</-'/ru7��_ ln�i� 9-- <br /> eaaecr aoone s�:.a„�., n,� <br /> �� 1 O�Ilbd" <br /> �L S L8' Lc� �U�EPa.'-Tr 1v F�' k Lo � �,,.P,...,,�,�„��.s=,.,, - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. 7VPE OF E�IIIPMENT FEE <br /> I ��� WATERCLOSET�TOILET) A�C-A:�GVL`lC UNITS-H.P. ' <br /> 1 — BATHTUB FORCED Alq SVSTEMS-D.T.I'. M E.A. � � <br /> LAVATORY�WASHBASIN) UNITHEAIERS-B.T.U. M <br /> ���' SHOWER CLOTHES DRYERS <br /> �+' KITCHEN SINK 8 DISP VENTILATION I"AN <br /> � DISNWASHER RANGE H000 <br /> LAUNDRVTRAY � WATERHEATEFi <br /> I '�d CLOTHESWASHER i WOODSTOVE - ; _ <br /> '�` URRJAL METAL FIREPLACE 8 C:�iMNEV � <br /> � DRINKING FOUNTAIN FIREPLACE INSERT � <br /> �LOOR DRAIN HEAT PUMP i <br /> � �� BA�KFLOW PRE\'ENTERS ; GAS PIPING � <br /> !�1�1 flOOF�RAINS-RAINLEADERS � EXHAUST F.4N i <br /> � SINK(SEflVICE-BAR,ETCJ � <br /> J i � <br /> !,�' . i 1 <br /> I <br /> ! SUB TOTAL $ SUB TOTAL $ � <br /> I ' � PERMIT $ T ___ PER�41T $ ; <br /> �� +rI i. TOTAL FEL $ TOTAL FEE $ —�— <br /> �. FOR OFFICE USE ONLY: <br /> FRONi5E1ItA�'N REAPSEIDRCK SIDESEiBALK Pi.ANCHCLNNUMOEfV fEE RECEIPiNO. <br /> NA- �JR� �1,4 0�71 d'! <br /> uselor+e �aen/(� � VACAIRSIiE FEES VALUATION FEE <br /> �3 �/d �� BUILDING � <br /> 1YPEOFCOIIiS.FL1044ABLC lYPEOFCOB51.AtIpAI Wcurev[r Hooroxm�uc�vv6 <br /> 4P0°° � PLUMBING � <br /> i <br /> SIZEOFBLDG NO.OFSiORIES BASEMENT MECHANICAL i <br /> J_ <br /> i <br /> . OCCUPANCYlOAD FA[SPflNKLCfiSREO�D HEIGNTLIMITATION '���rt S� /p - � �QG <br /> SPRINKIER i <br /> REASONFORSPR1NKlEHS � <br /> STATEUWLOINGSURCHARGE �( �ya <br /> INTAREBY AN$APPROVEDl1Y CITYOFEVERETT PUBLICIVOflK$ <br /> m LOCALSALES <br /> , <br /> � � TAX CODE IS 3105 rorn� �G �S � <br />