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APPLICA710"� FOI; CONSTRUCTI - N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPAFTMENT HL-A71NG SYu7EM: U GAS U ELECTRIC U ___ <br /> ------- —� <br /> 259•8810 • <br /> i_I DEMOUTION I I COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I J SIGN <br /> ownen unanooness arv zm �•uoNe <br /> x��rr ,�,�oo�+ s�r�, �o.� 3��-le w��a -a�o� t�55-113� <br /> TENAl1T M�IL�DOIIE.^i5 CITY ZII' PIION[ <br /> �` C�ce�nc�40-al.l 3003 ��ho ed t vere�}' <br /> AOCIIITECiO�DG5IGNEH MRIlRU0RE55 dtV LIP PIWNF <br /> GENEflALCONTRAGTON G�IIMOflC55 f,ITY 21P PIIONE STATELICENSEI <br /> l-umpkin Inc. I�v�� _as4la�cr Avr t�st �ea�l� `�810a �ry-�g <br /> MECIUNICA�CONTNAC70F MMI.ADDNE55 GfY ZII' 1'�IONP STAtEIICENSE� <br /> � C _po.$ox a�s�� Se�ttL _`L8�►}�ma- aai� mc�sN+��c aoN <br /> PLUMOINQ�• MAII A�DRESS CIIY 21P PIIONE SiAik LILLNSC� <br /> LONTflAtT PRIGE OF WOHN --'�— <br /> X � lSoG <br /> DESLf118EY/ORNAN SOUAREFOOTAGEINV VEO (;01lTR'TPEf50f1ANOP110NGN <br /> r Md �n� YC.�O�d��[�cls (�jnkl s X�tv�3_KCffiY].L�3_ ��laa2-?�311 rt./,z! <br /> � 5� <br /> � --- <br /> i HEREBY CER7IFY THAT I'HAVE HEAD AND E%AMINED THIS <br /> anoroseo use cF euaoin,a.,/�/� � APPLICA7IJPI AND HNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> M r� lJt t'1 CG PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE66LOECw)HIPTK)N PNUPEPTY�SIIOWNOEIOWOf1�TfAC11IWOfAPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIE� HEHEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE <br /> �or oiocK oF — AUTHORITY TO VIOLATE OH CANCEL THE PROVISIONS OF ANV <br /> OTNER STATE OR LOCAL LAW RE6ULATING CONSTRUCTION OR THE <br /> — , PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> . OWNER Of THIS PqOPERTY TO PERFORM THE WORK FOR WHICH <br /> --�— APPLICATION IS MADE AND •I COMPLV WITH THE STATE <br /> renctt rnx i o.r+uMeee • CONTRACTORS LAW'�8.27 RCW AND 29G.200 WAC. <br /> CONSTPUCTION LO�N LENDEfI.ADDHESS.IELEPNONE NUMOER <br /> r -�rn ia G <br /> PROJECT ADDRE83 X s�w�ui��e9�� — o�.e <br /> x aoo3 ('asino Qaad P�eir��'10- I.1 ��,.d,�=��E�,�E�u,� <br /> , PLUMBING MF.CHANICAL <br /> , N0. TYPE OF FIXTURE OR REM FEE N0. I TVPE OF EQUIPMENT FEE <br /> WATER CIOSET(TOILEI') � AIC—/uHNDLG UNITS—�H.P. ?— <br /> BATHTUD ; FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATOflY(WASH BASIN) �— UNIT HEATERS—O.T.U. M ; <br /> SHOYlER CLOTHES DRYEFiS —�— <br /> KITCHEN SINK 8 OISP ; VENTILATION FAN ' <br /> DISHWA:iHER � RANGE HOOD �— <br /> LAUNDR'ITHAY ' WATER HEATER <br /> CLOTHC:WASHER � WOOD STOVE ; <br /> URINAL A7ETAL FIREPLACE�WOOD BURNINGI <br /> DRINKWG FOUNTAIN FIqEPU10E INSERT <br /> FLOOR DfiA1N IieAT PUMP <br /> B.ICKFLOVY PREVENTERS ; G115 PIPING ' <br /> ROOF DRAiNS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> — ----- � <br /> � <br /> --� ----- --�— <br /> � , <br /> — � , <br /> � <br /> � , <br /> SUB TOTAL 3 ; SUB TOTAL S ; <br /> PERMIT S PERMIT S <br /> TOTAL FEE $ ' TOTAL FEE S � <br /> FOR OFFICE USE OP1LY: <br /> FflONTSETB�CN FE�RSETO�CN SIOESETBACK PLANCMELK MBER FEE RE l O <br /> Z�' S' �� , <br /> USEIONE ��ttneu vac,wtsrte FEES VALUATION FEE <br /> f I YES ❑ NO BUILDING ' <br /> irr[orcoqsr. r+�.oFSTORiEs �c�.xc, xuwowuuw�w���; -- � <br /> txouv p�UMBING <br /> i <br /> 61ZEOFOlDO. FIIIESPOINNLERSIIEO'D OASEMENT MECHANICAL �— <br /> f.l YES '..1 NO — <br /> OCCUPANCY LOM FIRE AUqM IICO�U HEIGIIf LIMIUTION ADDITIONAL PLAN LHECN � <br /> i <br /> OTHER � <br /> fiE�50N - —T <br /> STA7[OUILOING SURCNAIiGE � <br /> INT�NEOV PIV�:A��VEDIIY CITYOFEVERETT PUOLICWORK$ � <br /> � LOCAL SALES ' <br /> pATE ; �y�_S) TAX CODE!S 3105 rora � <br />