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G� APPLICATI�'"Y FOR CONSTRUCT"')N PERMIT � <br /> � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT r HEATING SYSTEM: U GAS U ELECTRIC f, 1 <br /> 259•8810 <br /> ❑ DEMOLITION I I COMBINATION �BUILDING I 1 MECHANICAL i � PLUMBING CI SIGN <br /> OMMER � M�II�D�qE55 pTV ZIP PHONE <br /> USN/i�/g /t�o .,?(i✓S l,/' �ts.�,o �o FK�e'�c'n �%a %f1o�1 '/ �'/ <br /> TENANi � �r S � � J y <br /> 7MMLA�DHESS CITv p�P p�pryE <br /> L��iTiv�� rQAO.y�TS ZS'7S l%� a�d QO :riiArT ��G N;� <br /> ARCHITECTORDE51(3NER MAILAOGIIE55 p�n 2�p � PHqlE <br /> � -�ns�-P,� „2.;ri /01/ sr_ S7, -$'r: c'�3F-�t.ndue l•�a, ��dz� s <br /> GENEML C�OTiIUCTOR NML�DDRE55 < ! <br /> ,� �G J 5���� Z�� P�E SUTELICENSE� <br /> CS��r+ c_ ��s;_ J'v�: s �, s,-, ,=�:_;��rr. �l-�q. vaz��.� <br /> MECNANiCqGONTq ;70R M/A�ODRESS CIiV 21c PNqlE ST�TELICEHSE� <br /> � � <br /> PWMBMOCON7R�CTJR �NfILAD�Rii55 �17Y ZIP pNONE SUTEIICENSE� <br /> V /f _ <br /> CONTR�CT PFICE OF WORK — <br /> /�f . �Od <br /> DE9CPIBEM/ORRANDSOUNNEfOOT�OEINVOVED CONI'�CTPERSON�NDPHONENO ' -- <br /> — _ ��� �/ ys �s�s=�3�� <br /> _�,J.a..,,- /�►, ,�dtirF'/l.a..iT � n //19��� �x�,� �,� <br /> �'i= ,�'i5-/iws --- <br /> — I HEFtBY CERTIFY THAT I HAVE flEAD AND EXAMINEO ThIS <br /> vmwoseo use oF euKorc�o APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT.ALL <br /> Of FiCrt� f!✓/�P�r f/d�< Sii PROVISIONS OF U1W5 AND ORD!NANCES GOVE:RNINO THIS TVPE OF <br /> LE311LOESCRIPTIONOFPqOPERtt�6110WNBFLW/OH�Ti�CNTWqCJPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �OT-- BLOCN cv NOT. THE GRANTING OF A PERMIT DOFS NOT PRESUME TO GIVE <br /> !, AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> _ /� /T�H��' OTHER STATE OR LOCAL LAW RE6ULATIN6 CONSTRUCTION OR THE <br /> FERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWfJEH OF THIS PROPERTV TO PERFORM THE WORK FOH WHICH <br /> PARCELT�%IDNUMBER APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTOHS LAW 18.27 RCW AND 296.200 WAC. <br /> GONSTRUCTqN LO�N LlNDER.AODRE53.TELEP110NE NUMBFR /� �_ �" <br /> x //Tlu.�y���,�,ta� �5�� /.� <br /> PROJECTADDRE88�+ f1 '\ y�axuune 3 ��- o�re <br /> � �L C_A..S�Nt� �+ U 't�-L�iI.E�/e'� urrws»�reeikcnser.o .. <br /> ��� MECHANICAL <br /> M0. TYPE OF flIfTURE OR ITEM FEE N0. TYaE OF EOUIPMENi FEE <br /> WATER CLOSET(TOILET) NC—A�HNDLG UNITS--H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.?.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRVERS �— <br /> KITCHEN S�NK 8 DISP ; VEN7ILATION FAN <br /> DISHWASHER RANGE HOOD , <br /> LAUNDRYTRAV ; WATERHEATEfi � <br /> CLOTHES WASHER WOO�STOVE ' <br /> _ , <br /> URINAL METAL FIqEPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN , FIREPLACE INSERT <br /> FLOOH ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GRS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) � , <br /> _ � <br /> — <br /> _ <br /> � <br /> ' — � <br /> _ SUATOTAL S ; SUPTOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE S TOTALFEE S � <br /> FOR OFFICE USE ONLY: �pn <br /> iRONT6ETBACK -- RE�HSETBr�CIt�� 510^SETBIICN PUNCIIECN UTABEP FEE�n ��� REGEN{T�NQ�^� <br /> 1 e �� aa <br /> 0 <br /> USE IONE LOT�REA V�CANT SITE FEES VALUATIOY FEE <br /> r� ' � Cl VES � � BUILDING � i <br /> IYPfOifAllSi M�OFSiORIES ocwnMtr rqaoNtumGUNiR <br /> "/ aawv p�UMBINO � <br /> //1 � <br /> 61ZEOF&D0. FIRESPRINifLER5RE0'D B�SEMENT MECHANICAL i <br /> /� SQ,t�. T, l, E ❑ ves r No <br /> oCw�. rLWD FPE�URMNEOD MEIOHTIIMITRION ADDiTIONALPUNCHECK ' <br /> � <br /> L _ OTHEH i <br /> AEASON — � <br /> STQE BUILDING SURCHARiE ; � <br /> i <br /> INiAI(EBI PLNSAPPNOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> �ml LOCAL SALES <br /> o•rE S,ZS-9� TAII CODE IS 3105 TOT�� 202 i;�z) <br />