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APPLICATIO�' FOR COkSTRUCTIAN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> r HEATING SYuTEM: U GAS ❑EIECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING 1�AECHANICAL I I PLUMBING I ! SIGN <br /> � <br /> OMME M�R�UDRE55 CITV 21P PHONE <br /> � ' � �Dr�� I/ �//.�� <br /> TE NT M�R DRE55 C�IY 71P PHONE <br /> �RC/IITECTOHDESI6NER M�IL�ODNE55 CITY ZIP PNONE <br /> QENEN�L CONTRAGTOR M�IL�DORE55 CITV IIP PNONE ST�TE UCENSE t <br /> � / � = �� Z(rb -GboG� _ • <br /> MECNANIC L CONTRACTOR M L�OOR 4 CITY ZIP PHONF ST�TE IILENSE� <br /> �'2�Nn►c-zL `i/'� .Pd?�z7k•.✓ C1'c���'f 3ss.3�!L r,eiN„���i37�F <br /> PLUMBMa CONTNACTOR M�II�ODRE55 � f.ITY IIP PHONC STQE IICENSE� <br /> CUSSOF WORI( <br /> r�1�NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLI'fION I I WOODSTOVEtfRPL INSERT I I BUILDING RELOCATION <br /> � �� CONT '7 PfRSUN�N�PHONE NO <br /> Cd17MCT PRICE OF WORK C�S On0 � ,��7-,�-,��f� 3SS-36/� <br /> DESCRIBE M/ORK�NO50UARE FOOT�OE IN VEO <br /> �,�r s�.c_,,,/��,?gct�.tir.ao.,✓ <br /> PHOPOSEDUSEOFBUIlDINO I HEHEBY CERTIFV THAT I HAVE READ AND E%AMINGD THIS <br /> ��Fr�z..�/NC+ APPLICATION AND KNOW THE SAME TO BE TRUE AND COF�RECT.P�.L <br /> LEO�LDE RIVTIONOFPROPERTV�SHONT/BEIOWOR�TUCNFWRCOPIES� PROVISIONSOFLAWSANDORDINANCE6liOVERNINOTHSP'PEU9 <br /> � WORK WILL BE COMPLETED WITH WHE'�HEf,SPECIFIED HERE. 'OR <br /> �o. a�xK 9�- � NOT. THE GRANTING OF A PERMIT DOES NCT PRESI:ME TO GNE <br /> � AUTHORITV Tq VIOLATE OR CANCEL THE N�IOVt�IONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSIAUCTION OR THE <br /> PERFORMANCE OF i:ONSTRUCTlON. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THiS PROPERTV 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 /> ��� �D'�-�- �i����,�l�.�,, ;7 9 -z_ <br /> PROJECT ADDRESS n srvemnf n�lF <br /> �i� � 7 crtrauswessiKrr�srrro <br /> PLUMBINO MECMANICAL <br /> N0, TYPE OF FIXTURE OR ITEM FEE N0. �YPE OF E�UIPMENT PEE <br /> WATERCLOSET(TOILET) � NC—NHNOLGUNITS—H.P. � <br /> —•-- <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK 6 DISP � VENTILATION FAN I <br /> DISHWASHEH RANGE HOOD <br /> LAUNDRY THA� ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPUICE 8 CHIMNEV � <br /> DRINKING FOUNTAIN � FIREPLACE INSLRT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING _� � <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN _ <br /> _ SINK(SERVICE—OAR,ETC.) ; . <br /> � <br /> ' " /!E h D <br /> � <br /> 5UB TOTAI S 1 SU8 TOTAL S <br /> PERMIT S � PERMIT S <br /> TOTALFEE S TOTALFEE E i <br /> FOR OFFICE USE ONLY: _ <br /> FRONTSETBACR REARSETB�CN � BIDE6ETB�CN PLANCNECNNUMBER FCE RECEIPTNO <br /> 37 <br /> USE 20NE l0T�REA V�CANT 6RE FEES VALUATION fEH <br /> BUILDWQ I <br /> TYPEOfLONIS�ILOW�BIF IYPEOfLON57/�CtWI accunuCr YodVM�liNnuhit� — I <br /> �"01° � PLUMBINO � <br /> ----i— I <br /> fiIZEOFBLIX3 NO.Oi6TORIES BASEMENT MECHANICAL �'' <br /> OGCUPMlCV lOAO FlRE SPRNNLEPS REOD dEIOHT UMIfATipl ADDITIONAL PLAN CHECK v 0 , <br /> — 1/D7 rC� <br /> SPRINNLEF � ' <br /> RE�SON FOR SPRINNlER3 I <br /> STATE BUIl01Nfi SURCHARGE � �, <br /> _ <br /> INT�NEBY PUNS� ROVEOB� CITYOFEVERETT PUDLICWUHKS ; <br /> h LOCAL SALES 253 J� I� <br /> ��'� TAX CODE IS 3105 TOTAL <br />