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APPLICATIO . FOR CONSTRUCT' �N PERMIT „� <br /> TO BF.COMPLETED IN BLACK INK-PLEASE PRINT �evrrkess <br /> HEATING SYSTEM: J GAS J ELECTRIC J __ . � <br /> BUILDING DEPAFTM[NT �-- - <br /> — ----- - . <br /> 259-8810 <br /> DEMOLITION COMBINATION ,� BUILDING MECHANICAL PLUMBING SIGN <br /> ---�--- --- ----- - ------ . ------ �— <br /> �v.4l,q� I,�n�l n i i '� f.lrv �r PIIONF �� � . � � 2 / <br /> 1C / -3 <br /> ��N �� _�.���LYl 1�.�-������,�:��— ' � a� `X � <br /> ❑�inr�l IAA P�p Eti5 CiiV Ti PIqN[ <br /> U��s _1����_L��,�-�v <br /> Nu'nnCCtOq0E51GNEA qDO�[SS City pip pHpryp - <br /> GCNF.It�LCONiRPCiOR AUIl40DRF55 CIiY ZIP P110NE STqTCIIGfNSE/ <br /> M[GN�NIC�IC(NliR�CTOA MAIL�ppNE55 CIiV IIP PHpNE STn:EIIG`�iE� � <br /> PlU1.IBiNGCONiR�CTOR MML�II�NE55 CiTY 21P PIKINE STQEL�GENSEI <br /> ff HTR�CT PRiCE O�WOR✓ - <br /> PfSC •�E WOfiK�Nfl SOUIfiC FOOII�GF INVOLVEO LpHi�f,l v[qmN�N�PHONE NO <br /> �C71J1_ � <br /> � .�r��1�__I—. _—_— - _. <br /> , _ ' � .o ��/ <br /> �-���� �.�,��is��V71�� - <br /> ���'<<'�� ! ��n�- i HEREBV CERTIFY THAT I HAVE READ AND FYAMINED THIS <br /> raorosEo u,e or pu i_mNc APPIJCATION AND KNOW THE SAME TO BE TRUE�NO CORRECT. ALL <br /> ._ PROVISIONS OF LAWS AND ORDINANCES GOVERNWG THIS TVPE OF <br /> i.ecn�oescamtronorpqoceRtv�si�owneeiowoReTr�r.Hnvocoaiesi WORK WILL �E COMPLETED WITH WHETHEfi SPEGFIED HEPEIN OR <br /> NOT. THF GPANTING OF A PERMIT DOES NOT PRESUME TO GN[ <br /> ��r- ���N oF - — qUTi10RITY' TO VIOLATE OR :ANCEL THE PROVISIONS OF ANY <br /> OTHER S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �- ----" PERFORIdANGE OF CONSTRUCTION THAT I AM AUTHOHIZE�BV THE <br /> OWNER OF THIS r ROPFRTY TO PERFORM THE WORK FOR WHICH <br /> ----- APPLICATION IS MADE AND I COMPLV WITH THE ST�T[ <br /> rnneei ux i o NUMoer+ CONTRACTQRS l W 1P.2i PCW AND 296200 WAC. <br /> i i <br /> - _—' , <br /> ;•.�R;inUC 1 iON I��nN�CNOER 1DDRE65,if.IEPNONE i.UMBER " 1 �/ <br /> — X � ��G.� � 7(fL� Y_�- 3� �/ �. <br /> PHOJECT ADDRESS / --- <br /> -- <br /> 3� ( c.0 in � ��s'�-� -'�y �lr-/� — — -- ---- �,�E _ <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSE7 �TOILET� � P�C-A'HNDLG UNITS-H.P. ; <br /> ._.___. _ _._.__.- __-_ _ ___. ._ ._.. ---_�- -___ -_-___— _-_-__,-__... <br /> _ BATHIU� FOfiCEDAIRSVSTE`dS-B.T.U. M EA. <br /> . _ LAVATORV(WA;H BASItJ) � _ UNIT HEATERS-8?.U. M <br /> SHOWER CLOTHES DRVERS T <br /> KITCHEN SINK 8 DISP � VFNTILATION FAN � <br /> ���- _D13HWASHEH --- �-�- �� HANGFHO00 <br /> LAUNORV TRAV - --�-� WATCR HFAi[R � <br /> CLOTHES WASNER r WOODSiOVF ' <br /> _ _.__ ' <br /> __ URINAL METl�L RR[PLACE(WOOD BURNING) <br /> DRINKING FUUNTAW �IRFPLACE INSERi <br /> FLOOR DRAIN li!-1T PUMP � <br /> _ BACKFLOW PREVENTERS i GAS PIPING <br /> R�UF DRAVlS-RAIN.EADERS EXHAUST F�AN --T- <br /> SINK 15ERVICE-BAR,ETQI --�— <br /> _ SUB TOTAL $ ' SU�TOTAI 5 <br /> _ _ .____ _. PEFiM1T 5 ---�- --- - ._-- PERMIT $ -- <br /> _ TOTAIFE[ 3 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> i��oarsere�cK n[nqsrinncK -� smFSFitinri� n�nHc�rtrKr�iin+nni rn nFceinmi <br /> y/<�•"�� <br /> a�..�loqt � iui�ne� WCANTSIIF FEES VAIUAiION FEE <br /> :�� VES NO ow�oWr, '°' <br /> - . , � <br /> --- �' <br /> nPlOICON51 M'lOFSTOPIES a[w�N:. Niatm., ,,�i�,�. —_- . . . --. . _--.—.__ ..._ . .__. '_.. _'_"..__. IJ.. . . . <br /> G0.p11c I ' <br /> L PI.U6IAMG ' <br /> :4F.OFBlDO FIRESPRINklCR5RE0'D B�SEMENt M[CHANICAL � <br /> ;.; VES :-� NO ----- -------- -------'- . <br /> UCf.UPqNCVIO�D fINEAIRlIMRCOU NEIONiIIAULATION ���ITIONALPLANCHECN <br /> _ __ -- _"— '_. " <br /> ._ __ ____. _.____ .____ O1HEf1 � <br /> nt.n50N ..._._ _--.._ --_— _. <br /> S7AT[OUIIDINGSURCHAfiCL -� ,/. .i <br /> .. __._-_ '_ '.__-- _".. .._ '_-_'__- _-- _." <br /> "' '- _".._ ..___.. . _.__-__ � <br /> ���rni<Fer vinr��;nri�no��nm� CITYOFEVERETT runncwonks <br /> LOCAL SALES :— <br /> i���� TAX CODE IS 31D5 rorn� � �• I�v <br />