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A�PLICATIC�I FOR CONSTRUCT'lN PERMIT � <br /> TO dE COMPLETED IN BLACK INK—PLEASE PHINT <br /> BUILDWG DEPARTMENT [ HEATING SVSTEM: �GAS J ELECTRIC J __ __ <br /> --� <br /> 253-8810 <br /> DEMOLITION COMBINATION BUILDING }(MECHANICAL PLUMBING I i SIGN <br /> M,, PIIONf. <br /> owNen ueaaooaEss --_— arv rn, — <br /> ''�RS. .CdNISE Mul i�F/LER zs Acut�o���u�. tuc,e�rr. 9 y,a�� �s,.� -9/8n <br /> lEN4NT AIA�IAD FE55 CI� zl' PHpNE <br /> PRCHIIECTO9�ESIGNER MAILApOFE55 Liiv IIP pNONE <br /> : �.t� � � , , _ , , � . �-��'��/ �s i - 9i8 � <br /> G[ � ql CONTRACTOR Uf�IL PDOf1E55 CIiY IiP PHONE $tATE IJCENSE Y <br /> MELIUNILALCONTRApTOB M,11L�D�FE55 CitY 21P PHONF 5(�IEUCENSEI <br /> PlUM01NG CONTMCTOF MAIL�ODR[55 CITV 21P PNONE ;;T�TE IICENSE• <br /> CONTRqCT PRIGE OF WORK <br /> /o2�Ja � �o,�vc< s s� "� - � L -33`J - �_3� 9 <br /> UE SCRIpE WOPN ANp$OUAHE FO7TRGE INVOLVE� CONi4Ci PEIISON�N�PIIONE NO <br /> rN6TALLA�1 a f CyAS NOT Lt.,�: <br /> TAIK . _ i HEFEOY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> PROPOSED USF OF BUIL�ING APPLICATION AND KNOW THE SP���TO BE TfiUE AND CORRECL ALL <br /> __ PROVISIONS OF LAWS AND ORCR.. :VCES GOVERNINO THIS NPE OF <br /> IEGALDESLRIPTIONOFPROPEfliVISh9WNBELOWOqAttAU11WOCOPIE51 WORK WILL BE COMPLETEU WiTH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMII� DOES NOT PRESUME TO GIVE <br /> �or eiocH --. oF ' qU7HOFITV TO VIOLATE OR CANCEL THE P90VISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW qEGULATING COMSTRUCTION OR TNF <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK fOR WHICH <br /> — AF'PLICATION IS MADE AND I COMPLY 1YITH THE STATE <br /> Pnacei tax i i. Nun+e��a CONTRACTORS LAW 18.27 RCW AND 296200 WAC ,/ (� " , <br /> CONSiRUC110NLO�NIENDER AODRESS.IELEPHONENUMDEf1 7 � / / <br /> �_ �1,�,�- � <br /> PROJECTAUDR SS n �(�� �. ��i, �� l _ oe�- <br /> II ��-�✓��. Ci1YBV5iNk55liCINS!NO <br /> PLUMBINO MECHANICAL <br /> N0. TVPE OF FI7(TUHE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� !vC—AiHNDLG UNITS—H.P. —� <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A � <br /> _ LAVATORV(WASH BASIN� UNIT HEATERS—B.T.U. M ; <br /> SHOWER �— GLUTHESDRVERS �— <br /> — —_i_ <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER RANGE HOOD �— <br /> LAUNORYTRAV ; WATER HEATER � <br /> _ CLOTHES WASHFR WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE�WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPIACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP �— <br /> , BA�HFLOW PREVENTERS GAS PIPING � <br /> ROOF ORAINS—RAINLEADERS E%HAUST FAN —T— <br /> _ SINH�SERVICt--bAH,ETQ) <br /> —— —�— <br /> �� <br /> I <br /> � � <br /> I <br /> SU8 iOTAL S SUB TOTAL E _� � <br /> PERMIT $ PERMIT $ /{; � <br /> TOTALfEE $ TOTALFEF $ . c �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCN REARSETBACN ISD[SETBpGN PIAb[Hf. K UM�GR FEE RECEIPiNO <br /> ���/ <br /> usezoNe I.OiANE� VACANiSRE FEES VALUATION fEE <br /> i ' VES � � NO our.owc ' <br /> � <br /> IYPfOfCON57 NODFSTOFIES ixcu>u�tr Noa��w�wxcuxn• — <br /> ���01P PLUM6ING <br /> SIZEOFBLW. FlHESPRINYLENSREO'D B�SEMENT T— <br /> � �, VES � � NO MECMANICAL _ — i <br /> _ � <br /> OCCUVqNGVLOAO FlREFIAqMHEOU HEIGRiLIMIIAtION <br /> AGOITIONAL PLAN CHECK � <br /> O7NER i <br /> flE450N <br /> STATE BUILDING SURCHAqGE <br /> INTAnEUV PUNS�PPROVC�pY CITYOFEVERETT Pl1BUCWORNS i <br /> LOCALSALES <br /> oa,� TAX CODE IS 3105 TOTAL ; <br />