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APPLICATIO�. FOR CONSTRUCTII .� PERMIT ���� <br /> TO BE COMPLETED tN BLACK INK—PLEASE PRINT <br /> HEATING SYSTFM: U GAS ❑EIECTRIC ❑ <br /> BUILDING DEPART!AENT <br /> 259•8810 <br /> ❑ DEMOLITION f 1 COMBINATION I I BUILDING I I MECHANICAL I 1 PLUMBING '�SIGN <br /> OWNEN MARADORESS GIfY 21P PIIONE <br /> `fNe- �ouTu�Anln cs�aPa0.RYlUn1 �a'.� ANDOVER PAPKW '�u1�Wi�A�. Wh981b5s ZAC S75 67// <br /> TENANT M�R�OORE55 CITY ZIP GMONE <br /> '7 E�EuEh� siaaE �(255z6 3�s E cAsin,u RD evF�e.Err, W[1 9a2�3 3'l7 77/7 <br /> AACNITECT 0�OESIGIIEN M�IL�DDRE55 CIIY 21P PIIONC <br /> .5E'!`� C N�.4A 7 <br /> OENEMLGONTRAGTON MAIL�DOIIE55 GIY IIP PMONE 6UTElICENSE� <br /> .-�,ye s�cni l,o i,vc Po 6o�s 33�Y3 s���e wq 9ei3� �S�v� 6zy �/z'�3 MfYERY�'2/9r3C <br /> MECNANICALCONTR�CTOR M�IIGDORE55 G17V 2iP PMONE 6TATElqENSE� <br /> N/q <br /> PLUMBINOLONTMCT011 M�RA�DRESS CIIY 21P PNONE BT�TELILENSC� <br /> Nl/k <br /> cuss oF wonrc <br /> ❑ NEW ❑ A�DITION I-I ALTEfiATION I_I REPAIR I I DEMOUTION I I WOODSTOVE/FRPLINSERT I-1 BUILDINORELOCATION <br /> � ca�ucr aEnsoN u+o mane ra. <br /> CONiMCTPPICF.OFW011K �i 7/�• �b z/1nIF P WIVSa� 6� �Z-Y�j <br /> D[SLPIUEWOf�NANOSdURCF00TAGEINVOLVED pe�tc y bJT <br /> I ,.� co ��F 1 u�tku- s� - <br /> vno se�u:�eoraw�on+c �— i HEREUY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> (��M�` APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEaLDESGRIPTqNOFPqOPGRTY�SNOWNOELOW011�77AGHFWPCOPIEb� PROVISIONSOFLAWSANDORDINANCESGOVERNIN6THISTYPEOF <br /> WORK WILL OE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br /> �or o�ocK � NOT. THE GRANTING O� A PEFiM1T DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �_syY n� F OTHEfi STATE OR LOCAL LAW RLGULATING CONSTRUCTION Ofl THE <br /> b�'�� PERFORMANCE OF CONST'�UCTION.THAT I AM AUTHORIZED BY THE <br /> OWIJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> //// W G � <br /> PnaecT•oonEss xwuu,�'�P� ���S f�— <br /> J.r. � C�'n.� f.�IvfltI5M551�f.lN:LN(1 <br /> P W MBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SVSTEMS—�.T.U. M E.A. �_ <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � . <br /> SHOWER ' CLOTHESDHYERS ' <br /> KITCHEN SINK 6 C!4P VENTILATION FAN �_ <br /> DISHWASHER RANGE HOOD _ � � <br /> LAUNDRYTRAV ; WATEHHEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIfiEPLACE INSFRT � <br /> FLOOR DFAIN HEAT PUMP ' <br /> 9ACKfLOW PREVENTERS GAS PIPING i <br /> qGOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) —�— <br /> � ' <br /> - ; __ <br /> i <br /> SU�TOTAL S i �� � SUO TO?AL S ' <br /> PERMIT f � � PERMIT f � <br /> TOTALFEE S TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN RE�RSETOACK SIDESGTOAGN PLANCNEGKNUMOER fEE HECEIPTNO. <br /> ' / �/ �� <br /> /-/ ��� 7� C r'�1 <br /> usE2oy( _ J �ornnu vecu�TsrtE FEES VALUATION fEE <br /> /i � <br /> L_/ OUIlOtNO � ' <br /> iYPEOfCONiS.ALLOWAWE IYPE0ICOHSI.ACNAL Ot`�Ki Yoav�luw4wiH � <br /> PLUMOING i <br /> � <br /> 52EOi0L00. NOOFSTORIES �ASEM[NT MECHANICAI � <br /> OLCUP/�NCY lOAU FlRE SPIINNLE115 PEO'0 HEqHT IIMIGTION A�OITIONAL PUN CMECN i <br /> � <br /> SPRINNLER � <br /> PE�SON FOfl 6PAINNLEf15 �/� <br /> STATfi OUILDING SURCHAHGE � (/ <br /> INT�NEOY r�,.nsnrrnovcoor CITYOFEVERETT PUOLICWORNS ; � <br /> dM LOCALSALES —T— <br /> � �� TAX CODE IS 3105 TOTpL � ?� r <br /> � <br />