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APPLICATI�Y FOR CONSTRUCT""9N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: rGAS ❑ELECTRIC i.J l <br /> 259-8810 <br /> ! DEMOUTION i I COMBINATION � BUIIDING 'MECHANICAL i i PLUMBING C I SIGN <br /> OWNER MRR4pDfi[SS QTV 2iP 1'MONF <br /> Ll�52i2S' L.�IfJIC _1���__J�_r,py_��d1i��!(t7'F�� �'iS'Z75 _353'- 20Q3 <br /> TEN�NT M�'L�ODRESS Cliv ZiP pqpryp <br /> �RCNIiE:TGPDlSIGNER MAIL�DDRESS CITV }IP pqpqE <br /> _�►(}I� E S Ii�IWET-f- I�Ir'o MA�t^uU EVEfit'Tf' 9S o3 363 US31 (.f�1 CE2rp �-e42 <br /> CENERnLC(1NTRnCTOR M�ILR�ORE55 GiY ZIP PNONE S7ATElICENSE� <br /> f����(�l �N'r'�,Zr2�srs 71�e Pnsox iRR deWcts._��1d9ggz�s �y�-3S77 �c�Nai K 2/yD �� <br /> MECM�iIC�LCO`lTRACiOR M�ILADORESS CI1V zIP PHONE 5!AT[lICE115E1 <br /> I�). �An-�C I�FO.TNL <br /> PLUMBING l ONTR�CiOR MRIL RDOflE55 CITY IIP PIIUNE STATE LICENSE� <br /> / isr�SarJ f�L , <br /> CON RACT PRICF'�F WORK -- <br /> L ` y �yg--�- iJ �.p_ <br /> JI <br /> ' DESCRIBf-W K AND uOU�RE F(qT�GE INVOLV D CONiqCT PENSON�ND PNONE NO <br /> 2 sTorcY NausF iz34 � Hr��— 745• 3577 _ <br /> I P,.GJ6aGG- A7ThCNE-0 %�� � i HEREBV CERT�FV THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEO 115E OF BIIIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> SCL. FAM Il5' RC-S1'DENCS'�- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEG�IDESCflIPT10NOFPRO�ERtt�ENOWNB[IOWOR�TTALHiWOCOPIf51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> wt � e�ceK � or -�Evc°ai[�Y NOiN°1� NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> � O. I V0L �O OF PtArS Pa 4. OTHER STATE OR LOCAL LAW REGULATING CONSTPUCTIOIJ OFi THE <br /> / PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BV THE <br /> C'�7- � ''�. ` � "��� �� OWNER OF THIS PROPERTV TO PERFORM TNE WOHK FOP WHICH <br /> PARCEITA%ID.NUMB <br /> � � -��� APPLICATION IS idADE AND I COMPLY WITH THE STATE <br /> �UFTtoi,1 GF�3�T3Cu ^��Cfi�-G'GO�I- CONTRACTORS LAW 18.27 CW A 296200 WAC. <br /> CONSTRUCTIONLO�NLENDER,��DPESS.TELEPNONE NOMOfR � <br /> WASN/i�4 Td�f/ �,'ct7v,4� 13AP�IC • � c":-` � 1 ; �,� _ 3,�i 4 / 4� <br /> PROJECTADOHE83 x�cr��runr - n��F . - <br /> 77O �. C'.Ac/�flE �'_ CL6I ETT' WA crvnusv�ssnur�sr r�n - <br /> PLUMBING MECMANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) ,. A�C-AMNDLG UNITS-H.P. <br /> BATHTUB v 7 � � FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> '> LAVA70RV(WASH BASIN) ✓ UNIT HEATERS--B.T.0 M <br /> SHOWER __ � CLOTHES DRVEHS <br /> � KITCHEN SINK 8 DISP VENTILATION FAN PajdCiN- <br /> � DISHWASHEF - RANGE HOOD —r <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNINGj <br /> DPINKING FOUNTAIN _ ; . FIREPLACE INSERT (yAS <br /> FLOOR DRAIN HEAT PUMP T <br /> BACKFLOW PREVENTEFS _ _� GAS PIPING __ Y <br /> - - --`i-�-- <br /> ROOF DRAINS--FAINLEADERS _ � EXHAUST FAN �r� pp..yp� __ <br /> SINK�SERVICE-BAR.ETC.) � <br /> — -� - <br /> I <br /> T <br /> SUB TOTAL E SUB?OTAL S 7/�`_ <br /> PERMIT $ PEHMIT S <br /> TOTALFEE S TOTAL FEF S <br /> FOR OFFICE USE ONLY: <br /> FRONiSE�BACN RERRSETB�CN SIpE5FT6�CK PUNf.�NEykNUM,ER FEE �^�^ RECE `) / _ <br /> —7�' 7-O � $J � YOn,> ,a a �i �� _3 S <br /> use zone- � iot naee veceNr sne FEES VALUATION FEE <br /> �. VES ; NO BUILDING �) � <br /> IYPEOIGON51 NOOFSiOR1E6 x�.nxr,r xao�umu�NGUNrts — �+ 7 — ��-- <br /> r,aqa. <br /> � .� �-- PWMBING \��. <br /> 5'Z^O�LD��Ft FIREBPRINNIERSREO'D BASEMEM � MECHANICAL „ � � <br /> �Z r G � vEs No �—_ <br /> ocCUv�NCv lo�o i-iaf nur+M REo�o NEw�rt uurt�nor+ ADDITIONAL PUN CHECK � <br /> / <br /> � -az"Ea- /�G�i/l) /l� I — <br /> fE�SON —�— <br /> STATF BWLDINO SURCHARGE �_�L� <br /> INiANEBY %�NS�PPROVEOBY CITYOFEVERETT PUALICWORK$ �'� i <br /> LOCALSALES <br /> onte y��97 TAX COOE IS 3105 TOTAL � 7� 1 <br />