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APPLICATi�'""1 FOR CONSTRUC7�ti PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> _ _-- --- _----- --- <br /> BUILDIMG DEPARTMENT HEAiING SVSTEM: LJ GAS �ELECTRIC J_ ____ ___--_ <br /> 259-8810 <br /> � ! DEMOLITION COM 31NATION X BUILDING I I MECHANICAL �' I PLUMBING i I SIGN <br /> OWNER MRiIRpDfIf55 CIiV ZIP �w PHONE <br /> TENAN/'7�P�/�/rllJ(!l(1,�ES/�GO/ 7� iL�.TJLL II++�—/-rwY� ��ONE� ��J�� � <br /> �RCNITECTOR[lES�CNEP M4ilq0UPE55 Cliv AP PHON[ <br /> GEN,E(R�RL CONiR4CtOR M�II�O�RESS CITY ZIP PHONE STATE IICENSE t <br /> l/lAJ M/U —_ <br /> MECN�NICRLCIXJTRACTOR MAI��DDNE55 CiTV ZiP PHONE STATEI�C[NSE� <br /> PLUMBINGCONIR/CTOR M�II�D�RESS CITV ZIP PHONE STFTEIIGENSEI <br /> (�Dr�,i.RAGT PBIC Oi WORN / Q � - / <br /> rCt�l�� dv� C��lO / Ja--' ��Y��-�J-�/�U�7_ <br /> DESCRIBE WOfIN�NO SOUARE FOOT F INVOIVE /��� � CONInCT nER50N�NO PHONI HO��' ][, l�p�_ 6?9 <br /> F�„'�I�� — <br /> /'��E I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIIDING y� APPLICATION AND HNOW THii SAME TO BE TRUE AND CORHECL ALL <br /> S//�GL/�'�y �/1jS)�// PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LSGAL�ESGNIPiIONOFPROPERtV�5116WNBElOW�OR�-177qCNTWOCOPIE01 WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> Ls� _� KF7���/ NOT. THE GFANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br /> l0� ALOCK OF ���� f— AUTHOPITV TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> ���a7�' n/y�._�/�,���Ih/� �r1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ��`}�i`�� �� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> �C / �� y �... OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> aY���+--/—�-��=g��—W APPLICATION IS MADE AND I COMPLV W�TH THE STATE <br /> PARCEL T�%Ip NUMBER CONTRACTOR LAW 18,27 RCW AND 296200 WAC. � <br /> 399G - m/ - 4� - Oo <br /> CONSTRUGTION IOAN LENDER.ADrr��S.TELEPIIONE NIIMBE F <br /> r y 8p�/r1�.9�tSF/Y c.,�G,��t o 6-y y3 <br /> PROJ CTADOHES s-� ina ouE <br /> s <br /> �/Qf C�/�CF• �rvnvsnrtssi�crHsi.rci <br /> PLUMB11�6 MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLO•`iET(TOILET) A�C-h�HNOLG UNITS-H.P. <br /> BATHTUB . ; FOqCEDAIRSYSTEMS-B.T.U. M E.A. 1_ <br /> LAVATORY(�NASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES C'iYERS � <br /> HITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATEF HEATER <br /> CLOTHES WASNER WOODSTOVE <br /> URINAL ME7AL FIREPLACE�WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSER7 <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> POOF DRAINS-RAINLEPDERS E%HAUST FAN <br /> SINK�SEFVICE-BAR.ETC.) <br /> -- � - <br /> SUB TOTAL 5 SUB TOTAL S <br /> P�RMIT 5 PERMIT S <br /> TOTALFEE E TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> fRON7SETBAC; �[RRSEiB� � SIpF.SETBP�N FLANCHECNOU�� � FEF/� �,� PECEIP�� <br /> o Z S '� % <br /> usc 7or+ iot nNr vnr.nNr�ire FEES VALUATION FEE <br /> /��� _ �DC6 _ �YES _NO BwtDwG � / � O � �J�J <br /> —�= S Z <br /> ivPFOfGON51 NOOFSTORiES ixa�-.xrr xamow��.nm�irns — —�-- <br /> � � �•"rtl` ' PWMAING <br /> SREO�BLLG FINESPRINMLERSREO'� BASE4[Ni MECHANICAI � <br /> I�'�S Sf fnN !o � vE� �io !-- <br /> OCGUP�NCYLOAp FIflE�URMRE00 M[IGHT�MIIAiiON� AD�I110NALPLANCHECK i <br /> _� J I_�8_ pTHER ' __ <br /> nr nsori - <br /> STAiE PUILDING SURCHARGE U <br /> �Ni.�io� rinNsern,a�v�onv CITYOFEVERETT pueur,wonks <br /> ���' LOCAL SALES <br /> ,,.,, �/,,,/,�� TAX CODE IS 3105 TOTAL — <br /> �- <br />