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�APP�ICATIO �' FOR CONSTRUCT(�`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �HEATING SYSTEM: J GAS J ELECTRIC J <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING I : SIGN <br /> OWNER MRIL 11Df1RE55 CIiV ZIP PHONC <br /> ccs�� �a���a� a�o� c�u�e,u� �v��r wa ���oi asy-� �� <br /> tENRNT MRIIRDDRE55 CiiV 21P PNONE <br /> �RCHitEC70p0I51G:1ER MMLRDDNE55 CITV 21P PNONE <br /> N F� <br /> �GE RRL ]NT{i OR �Il� DRE55 QTY 2iP PNONE STRT LICGNSE� <br /> [D�v �ftio �t� irs-z P.,,�,��,,cy �r�t.a 9r,cr� G �s—a�,� �ic�c.suaio•� <br /> �MECH�NIC�ICONiRACtOP M�IL�DDRESS QTY 21P PNONE STATELICENSE� <br /> PWMBMGCONiR�GTON M�IL�DbRE55 p1V 21P PNONF. ST�tEIICEN5E1 <br /> CONTRqGT PRICE WONN <br /> /U�p/D•D d <br /> DESCRIBE WORN RND SOU�RE FOOTAGE INVOLVEy�o^,,, e,��n ^�/� CONTRCT PERSON�ND PNONE 110 <br /> T Mi�. ft� i�• (: <br /> II�+�r Aoue.s, �U r✓IODuIS _ <br /> -T <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEDUSE Of BWLDINO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGMDESCNIP110NOFPROPERTY�SMOWNBEIOWORRiTRCHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or �� � oc�� e AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> p R, OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> P�RCEL TA%I D N'JMBER CONTRACTO L W 1827 RCW AND 296.200 WAC. <br /> �STRUCTIONLOfN1EUER,�IDDRE55rT�EPHs�UMBEP /_ Z�,! C`� <br /> C d / �� //- Y�r f <br /> PROJECT ADDRESS s�cxerune n��e <br /> G�1r0USMf55UC[NS[NO <br /> PLUMBINO MECMANICAL <br /> NO. TYPE OF PII(TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> BAIHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> IAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M I <br /> SHOWER CLOTHESORVERS � <br /> KITCHEN SINK 8 DISP � VENTILATiON FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIHEPLACE(WOOD BURNING) ' <br /> DRINKING FOU�ITAIN FIREPLACE INSEfiT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.1 <br /> � <br /> SUB TOTAL S i SUB TOTAL E _j_ <br /> PERMIT S � PERMIT E <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FPONT SETBRCN RE�R SEiB�CK SIDE SETB�CH PI�N CNELN NUMBER �EE RECEIPL NO <br /> lISE IONE LOi ARE� V�CANT SITE FEES VAIUATION FEE <br /> � : VES �-� NO BUIIDING ��� �(�� <br /> TYFE Of CONSI NO OP STORIES ottuwxc+ Na p mvtwxc uxns i <br /> �"a° pLUMBING ;�� <br /> S12EOiBL00 FIRESPRINNLEHSNEO� B�SEMENT MECHANICAL <br /> �-'� VES : '. NO — � <br /> OCCUPANCVLW� FIRE�I�RMPEO� HEIQNTIIMIT�iI(kl AO�ITIONALPLANCHECK � <br /> i <br /> OTHER ' <br /> RERSON <br /> � STATE OUILDING SURCNARGE _��Q <br /> INT�NEUY PLANSIIPPROVEOBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> „p�E TAJ(CODE IS 3105 70TAL <br />