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APPLICATIQ ' FOR CO 7' <br /> TO BE COMPLETED IN BLACK INK—F'LEASE PRINT <br /> f HEATING SYSTEM J GAS J ELECTRIC J � —--� <br /> eUILDING OEPARTMENT <br /> 259'8810 MECHANICAL PLUMBING SIGN <br /> �COMBINATION BUILDING <br /> DEMOLITION Z,� r�or+e <br /> 0,4�, �L 1U ��Ao��E�S , �lam _ ��,. �,�c �� ��,oN� 7��.����----- <br /> IEN�Ni <br /> � eua eooAess arv <br /> C'r Z�p PHONE <br /> nRCNrtECTORDE5IGNER M�iLA0DAE55 _ <br /> Z1P PNONE ST�TE UCENSE• <br /> G[NERILGONiR�CTOR <br /> M�it RDDRESS ��T� <br /> Z�p PNONE STQE IIGENSE r <br /> MECH�NiC�lCON1N�CTON MAII�DDRE55 <br /> CITv <br /> Z�p PNONE ST�TE lIC[NSE� <br /> P WMPiNG CONTR�CTOi <br /> M�IL�DDAESS CiTV <br /> �pryTq�CT PHICE OF WO`�N <br /> `� CONT�Ci PERSON RND PNONF.NO �„ <br /> �ESCRIPEWORRRNOSOWREFOOTAGEINVOlVEO 0 � . � � <br /> � / � cc s f c� 1 -11 �J_ <br /> T�,,r � , n� �i�a rD�i � <br /> C,� T' / ��� I HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> ��'�' APPLICAiION AND KNOW THE SAME TO BE 7RUE AND CORRECI. AlL <br /> raovoseo us.or u DiNG pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �ec��oes RloiIONOFPFOPE�T�15HOWNBELOWOAAiUC11TWOGOP�E51 N�R THELGRA TOING OF AD ERMITyDOES NOT PRIESUMEETO GIOVE <br /> ioT BiaK oF --�— AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ---------- PERFORMANCE OF CONSTRUCTION. THAT I AM AUiHORIZEO BV THE <br /> OWNER OF THIS Pi70PEf7?V TO PERFORM THE WOFiK FOR WHICH <br /> APPLICAT ON I MADE AND I CO LV WITH THE STA7E <br /> � 7 p NI CW AND 2 . 0 WAC. <br /> P�RCELiR%/I.)p N MB[R ,/r ��/�L�, / . <br /> CONSTRU�NN�oNIEN��OR� 1ELEPNONENUMBEF <br /> .G� � . _� 3�' � <br /> �,.,� <br /> , .,,��„ _ <br /> PROJECTADDRESS � rnvnovu�s�i"�r'�'i "'�'— <br /> MECHANICAL FEE <br /> PLUMBIN6 FEE NO. TVPE QF EOUIPMENT <br /> Np, TVPE OF PIXTURE OR ITEM p��—A�HNDLG UN'�TS—H.P -- <br /> WATER CLOSET(TOILET) FORCED AIR SVSlEMS—B.T.U. M E.A. <br /> � BATHTUB UNIT HEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) CLOTHES Df"'F9S <br /> SHOWER VENTILATIO. I ---�— <br /> � KITCHEN SINK 6 DISP RANGE HOOD <br /> DISHWASHER WATER HEATER _ <br /> LAUNDRV TRAV � yyppD STOVE <br /> CLOTHES WASHER METAL FIREPLAC[:IWOOD BURNINGI <br /> URINAI � FIREPLACEINSERT ' <br /> DRINKING FOUNTAIN HEAT PUMP — <br /> FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTEfiS EXHAUST FAN — <br /> ROOF DRAINS—RAINLEADERS <br /> SINK�SERVICE—BAR,ETC.) <br /> SUBTOTAL S _ <br /> SUB TOTAL $ pEFM1T S - <br /> f'ERMIT S TOTAL FEE S <br /> TOTALFEE 3 <br /> FOR OFFICE USE ONLY: — �FE necei�i No <br /> PLRNO�E .NUM9F� <br /> �RONiSEiB�CN REPRSFIBACK $IDESELBAGN / �� � .� <br /> ' � FEE <br /> VGC�NT SITE ,1 <br /> FEES VALUATION <br /> USE IONE 101 AREA -� YES N� BUILDING �~ 'v� <br /> NO Oi SiORIES w[,^�nn ua ro owlu'4ne•.�c ----- ��L� <br /> IrvF 0�[ON51 ��^��° PLUMBING <br /> a /� i �(—) <br /> SiZEO�BIDG FlNESPRINNLEPSREO'D B�SEMENT MECNANICAL _ ___ — <br /> VES NO <br /> NEI6NilIMIi�TION AOOITIONALPIANCNECN _ — <br /> OCCl1P�NCVLO�D FlFE�L�AMREOD I <br /> OTHEFi __ <br /> r+rntii�n STATE BUILDING SURCHARGE _�,��� <br /> — �� �- �� - � t'i�NSRPPROVfDB'/ CITYOFEVERETT PUOIICWORNS � <br /> '"�°"' "r LOCAL SALES <br /> nnrr <br /> TAX COUE IS 3105 TOTRL �� '��� <br />