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APPLICATIC�1 FOR CONSTRUCT )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT � HEATING SYSTEM: 1.]GAS U ELECTRIC U _ � <br /> 259-8810 <br /> I I DEMOLITION f I COMBINATION I I BUILDINO I I MECHANICAL ; 1 PLUMBING f 1 SI(3N <br /> OWNER M�R�DDRF.55 CITV IIP P1104E <br /> �e1�o � YV�rAC'�� I�� Snrcr�„h�� 14� L� S}e�ens 9ga1�,g 33>-�II33 <br /> TEN�N7 M�II AD�PESS � Ci V 21P VHONE <br /> �RCHRECiONDESIGNER MAI��OORESS CITv IIP PNONE <br /> GENERAL CONTIi�CTOR M�IL AD�RE55 CITY TIP P1qNE SUTE LICENSE/ � <br /> MELNAhICAL CONTR�GTOR M�IL��DHESS LITY ZIP PIqNE S1�TE LICENSE/ <br /> G�s�-� r•� 'pr�c.:e, 1o91d . h7 i1. N£ lup�c(,.�D w?. 9tp39 427•465¢ Cescof-P -��e•,d/y <br /> P[CRISIIIC CONTR�CTOR MRII�D�RE55 CITY 21P PNONE ST�LE LICENSF� <br /> �'r:��4� <br /> CONTP�CT PRIGE OF WORN <br /> DESCRRE VIORK AND SOWRE FOOUOE INVOIVED CONUGT PERSON�ND PNONE NO <br /> Fi1� SyR/NKLER �s+�l/ar,:n 20�3 E����,(,�' �29- �`Sft <br /> Z� ���� 7�L 1 HEREBV CERIIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPO USE OF BUIlDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.ALL <br /> O PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> lEO�LDESCRI TqNOFPPOPERTVISNOVMBELOWOR�iTACNTWOCOPIESI WORK WILL BE COMPLETED WITH WHETHEfi SPECIFIED HEREIN OR <br /> NOT. THE GRANTING GF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior BLOCK oF AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> JTHER S7ATE OR LOCAL LAW REGULATING CONSiFUCTION OR THE <br /> — — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORY �nR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH '(HE STATE <br /> P�RCEL T�X I D NUMBER CONTRACTO S LAW 1827 CW AND 296200 WAC. <br /> CONSTRIICiIONLO�NIENUERA�DNE65,TE1 MONENUM9ER n/ 'IO �� <br /> V 7 <br /> PROJECTADDRE S s"""0"` p1E <br /> f.ilvPUSM[3610ENSf Ip <br /> PLUMBINO MECHANICAL <br /> NO. TVPE OF FDITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES ORVERS ' <br /> KITCHEN SINK 6 DISP VENTILATION FAN ' <br /> -T <br /> DISHWASHER RANGE HOOD <br /> LAUNORV TRAV ' WATER HEATER � <br /> � <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOf DRAINS—RAINLEADEFS � EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) � � <br /> � <br /> T <br /> SUBTOTAL S SUBTOTAL $ ' <br /> PERMIT S PEHMIT $ <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RE�R SETB�CN SIDE SETBRCN PIAN CNE`%%UMBE� �EE �� RECEIPi NO <br /> 7, <br /> use zor+e LOT�REA VAC�NT SITE FEES VALUATON FEE <br /> f� VES �. �: NO BUILOING ' <br /> iYPE Of COHST NO OF STORIES atururtr Na q mnwMbuxns � <br /> 2 F�{N1° .Z PLUMBING _ <br /> r� <br /> SIZE OF BlDO FINE SPRINNLENS REOD B�SEMENT MECHANICAL � <br /> �(�LJ i�l VES �NO � <br /> OCCUP�NCYLOAO FIRE�L�RMREOD NEIGIITIIMIiAT10N A�DITIONALPUNCHECK i <br /> i <br /> OTHER i _ <br /> REASON � <br /> STATE BUILDIN SURCHTNCE <br /> INTAKEBY �L�NSAPPROVE09V CITYOFEVERETT PUBLICWORKS <br /> �)M LOCAL SALES � <br /> op,E 7 � y� TAI(CODE IS 3105 TOTAL � � <br />