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APPLICATIO'"`� FOR CONST�tUCTf �W PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> — - - -- - - -- _ - - <br /> - . ._- - -- <br /> HEATING SYSTEM_ J GAS J ELECTHIC J -- - <br /> BUILDING D[P�RTMENT - <br /> 259-8810 <br /> �( DEMOLITION COMBINATION _ BUILDING _ MECHANICAL PLUMBING SIG'N <br /> owr�rt��')—��2-f�-��n[ss cirv .�� rr�oNE <br /> �' ���rirn ,rL< < `f OTL3l��� .c/�n/L= �`�' ���� ' ��' �,,10_3 �� F. -,jS" �-r("7.5�� <br /> iCNANt � MRILRUDRE55 Cliv PP PHONL <br /> RRGMITECTORDES�JNE¢ MTRFD�HE55 Cliv 21P PnON[ <br /> .��L, -1, sTi;i � i9 _ <br /> G[NERAL GONiRAG10A MAiI AODRESS CITV I�P PHONF STPLE ll�/ � <br /> � �So/�T.l J �7� / S�D7 67f/, 2��e �) h CP2[�e ���� L4,� [�)A� G� (�A,[ c't�o7�0 <br /> MECNPNICALLONiRRC*OR MRILRU�R 'S CITY LC PM NE ST�TELICENSE� � <br /> PWMBINGGONiRAL10R M�ILApDRE55 CIiV 21P PMONE STAIEUCENSE� <br /> CONTRRCT PRICE OF WORN <br /> � DESCRIBEWOPKAN�SOUAREFOOLRGEiNVOLV[D �`.�\O� LOHTAGiPERSONANOP110NEN0 <br /> 1 � <br /> �_T��'S,�/t �_ — <br /> L21��—�-- <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PqOP05EDU5E OF BUILOMC APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PRCVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGRlO[SCRIPTIONOFPROPERiVISHOWNBEIOWOR4ITA:NTWUCOPles1 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR <br /> J / NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �Lot O O S B��K O� pF �s�/� � n' qUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOIJ OR TNE <br /> PEflFORA1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWtJER OF THIS PROPERTV TU PERFORM THE WORN FOR WHICH <br /> __ APNLICATION IS MADE ANU I COMPLY WITH THE S7AiE <br /> rear,e�rna i o rvuueea CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � o • onc _ n S� o / � Z 7 <br /> CONSiRUCtIONLOANIE`1DER AD�RESS.iEIEPHONE NUMBER C �3 <br /> � , � _ - .(.i/9?�/OL! 1/1 J � �� <br /> PROJECT ADDRESS �i01 �� � - <br /> +Yt '.}b'oS�jN ��'�����L.ANL' -EG' - lti' ��an ' ��� ��,�s���zs�����s,��,, <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A�C—A�HNDLG UNITS—H.P <br /> BATHTUD FOFGED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRVERS _ <br /> KITCHEN SINK 8 DISP VENTI�ATION FAN <br /> DISHWASHER FANGE HOOD <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTHES WASHER NlOOD STOVE _ <br /> URiNAL METAL FIREPLACE(WOOD 9UFNINGI _ <br /> DRINKING FOUNTAIN FIFFPLACE INSERT _.�_ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DflAINS—RAINLEADERS � EXHAUST FAN <br /> SINK BERVICE—BAR,ETCJ _ <br /> T <br /> SUBTOTAL $ _ SUBTOTAL $ <br /> PERMIT $ PERMIi 3 <br /> TOTAL FEE $ TOTAL FCE $ <br /> FOR OFFICE USE ONLY: <br /> FRON15E1P�GK REMSEtPACN SiDE5ETB4CN �IFNCNC 'n1llI1.111�fR+ fLF RFCU�iNO <br /> '//J <br /> use zoNe iot naen vncnNT srte FEES VALUATION F�E r_ <br /> VES � � NO BUILDING <br /> Irof 01 GONSf NO OF STONIES n n.�n .�ni own r4c un^s -- <br /> r,"",. pLUMBING <br /> Si2EOFBlIX'i FIFESPRiNNLERSREO'D BpSEMENi MECHANII'AL � <br /> • _L_ <br /> YES � NO -- -- — <br /> nr'CIIP�Nf.VIO�D i��EnlnnMR[on HRG�auuiiAnGN AJDITIONALPLANCHECK � <br /> ..__...__"____________—" —' —'._. <br /> I OTNER � <br /> �IAtiGN <br /> __— ___—— —. ___._ __—�--_. <br /> i1Ali_ BUILDWG SUfi' 4FRGL _ , <br /> .-- . - ___—__.__. .._ <br /> ' _._"'_.—_—_"— " <br /> �„��;.wi-i�. r�nr�snrcaovrnev CITYOFEVERETT ruei.ir,woaHs <br /> LOCAL SALES <br /> „�„ TAX CODE IS 3105 TOTAL <br />