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APPLICATIC'�1 FOR CONSTRUCIT .�JN PERMIT � <br /> TO BE COM�LETED IN BLACK INK—PLEASE PRINT rr <br /> BUILDING DEF'ARTMENT HEATING SYSTEM: �GAS U ELECTRIC ❑ <br /> 259•6810 <br /> DEMOLITIOk COMBINATION BUILDING /�iAECHANICAL PLUMBING SIGN <br /> R MMl�00RE55 CITV 21P PHONE <br /> D.m� �a P1�i. ss� ,3 <br /> T�� � � 'M�IL�DORE55 C11V ZIP PMpNF. <br /> PRCMITECTORUESIONER M�RAUDRE55 �ITV zip p�pryE <br /> �ENERQ CONTRAGTOR M�II�DDRE55 CITY tlP PIIpNE ST�TE LICENSE I <br /> G�ECIJ�NICQCd1 Gt�� M�IlI1DORESS LITY ZIP ���IK/6� / STRr��//�//rE///IC.JOUNC/ <br /> ����1 <br /> %UMBINOCdITR�CTOR M�R�DDREfS CITY ZIP PIpNF 9TATE4GENSEI <br /> cuss oc wonK <br /> I I NEW �� '� ADDITION ALTEHATION ' REPAIR DEMOLITION WOO�STOVEiFRPL INSERT BUILDING RELOCATION <br /> /� CONUCi ER NDPHONENO <br /> CONTR�CT PRICE UF VIOAIf l7� • y 6 <br /> DESCRIBE WORK 11!D SIX1A FOOT�OC INVOLVEO ��,�///_ <br /> � � /(.rf. <br /> PPOPOSEDUSEOFBUILbMICi I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED TNIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEWLL DESCRIPTpN OF PROPERTY�SHOWN BELOW OP�TTACH FWR COPIE51 PROVISIONS OF LAWS AND OFiDiNANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> toT eiocK �F NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PHOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OB THE <br /> PERFORMANCE Of CONSTHUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEHFORM 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 /> � `�S — W�WV� �i1�4�'�G�T/�/�C N/'f /7�7 <br /> PRO.IEGT�DDRE68 SqN�*un[ ouf <br /> '�. cirv n•s+rtse i�ctrist w <br /> � PLUMlMO MECMANICAL <br /> N0. T1'PE OF flIITURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> ' WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br />�� ! SHOWFR � CLOTHES DRVEHS <br /> , KITCHEN SINK 6 DISP ; VENTILATION FAN ! <br /> � DISHWASHER � � RANGE HOOD � <br /> � LAUNDRY TRAV ; � WATER HEATER <br /> ! CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEV <br /> DRINNIN6 FOUNTAIN � FIREPUICE INSERT ; <br /> FLOOR DFAIN � HEAT PUMP � <br /> BACKFLOW PREVENTEHS ; OAS PIPINO ! <br /> ROOF DRAINS—RAINLEADEFS � EXHAUST fAN <br /> SINK(SEFVICE—BAR,ETC.) ; i_ <br /> � , <br /> � , <br /> � <br /> � <br /> SUB TOTAL S � SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE E ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLV: <br /> Ff10NT BETB�CI( RE�R RETBACN 61DE SETB�CR PUN CNECN NUMBER FEE HECEIPT NO <br /> usezone LOi�HEA VAC�NTSITE fEES VALUATION FEE <br /> BUILDING i <br /> TYPEO�LIXliS.AILOWABLf TYPEOitONSi/�CNAI octUMxn rropoM��iNnwn! <br /> oaoUv � <br /> PLUMBING <br /> BREOFBLDIi NO.OFSTq11ES BASEMENT MECHANICAL <br /> OfCUPANCYL0�0 FIqESPRNNlER5RE0'D MEK3NTLM/IT�TION ADDITIONALPUNCMECN i <br /> SPRINKLER � <br /> i <br /> � <br /> RE�90N Fpq SPRINNLERS <br /> STATE BUIL�INO SURCHAHQE i <br /> kITANElY P�ANS�PPROVEDBV CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SIILEB � <br /> TAX CODE IS 3105 ro*�� � <br />