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,APPLICATII:� FOR CONSTRUCI .ON PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> r - - -- _ __ _ _ � <br /> I HEATING SYSTEM: U GAS U ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> O1VN MRILADDRESS CI7V 21P PNONE <br /> P/ 7� <br /> TEN�NT M�ILAD�RE55 CITV ZIP PIYJNE <br /> �RCHITEC70PDESIGNER M�IL���RE55 CIiY 21P PMONE <br /> GENFNAL CONTRACTOR M�IL�ODRE55 GITV ZIP PIION[ Si�TE UCENSE� • <br /> VE• µ�� 7P�� y;����55/ /� GtY 21P — PHONE S1�TE LICENSE/ <br /> ��� � / <br /> A � <br /> P�.UMBINOCONTR�CTOR M�IlA0DNE55 CITY 21P PHONE STRTELICENSE• <br /> GIASS UF WORI( <br /> � . NEW ADDITION ALTERATION FEPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> CONTAf.I PERSON AND GHONE NO <br /> CONTMCT PflICE OF WORK <br /> OESLRIBE WORK�ND SOU�RE FOOUGE INVOLVED <br /> PROPOSEDUSEOFBUIl01NG i HEREBV CEFTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGQOESGRIPTIONOFPflOPERTV�SHOWNBELOWORAT1�C11FWRGOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNING?HISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHE7HER SPECIFIED HEREIN OR <br /> �ot eiecK ov NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GWE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRI�^T'�N.TFiAT I AM AUTHORI2ED BV THE <br /> OWNFR OF THIS PROPERI'� ) PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE .D I GOMPLY WITH iHE SlA�4 <br /> CONTRACTORS LAW 1B.27 RCW AND 296.200 WAC. <br /> x <br /> PflQIEGTAU�RE55 ` �J/ srcri�tuni oe�[ <br /> � /� `)(p �uvnus�Hissucrr�srr�o <br /> PLUMBINO MECHANICAL . <br /> Np. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) Z aC—NHNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) S� — UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> T <br /> DISHWASHER RANGE HOOD <br /> IAUNDRY TRAV ' WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL Q )' ` METAI FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIFEPLACE INSER7 <br /> FLOOF DRAIN � HEAT PUMP _ <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS — �Z E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) _ ^� — <br /> Ew�c. r�� tc� L, � � --- . , �— _ <br /> �E � � <br /> ui - � <br /> W M1SI'� � 'F�l�ba `1 <br /> �� I <br /> SUB TOTAL $ � SUB TOTAL S <br /> PERMIT $ PEFMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FAONiSETB�CK REARSEiB�CN SIDESETBACK PUNCHECKNOMBER FEE PEGEIPTNO <br /> USEIONE LOT�RE� V�C�NiSITE FEES VALUATION FEE <br /> BUILDING <br /> IYPEOfGONISAIIOWliOtE IVPEOfLONSfAGNAI otcuvwn NoaDw[uM5oMn5 <br /> �qp10 PLUMBING <br /> 52EOFBLDG NOOFSTORIES BASEMENT MECHANICAL ����L� <br /> OGCUPANCYLO�D FINESPPNNlEN5RE00 HEIGNTLIMIIQION ADDITIONALPIANCHECN "7�I(�'J ���I <br /> I SPRINKLER <br />� REASONFORSPRINBLEHS <br /> STATE BUILDING SURCHARGE <br /> � _ <br /> INTANEBY PlANS�PPROVEDOv CITYOFEVERETT PU�LICWORKS <br /> LOCAL SALES � <br /> TAl(COUE IS 3105 TOTAL � � 2 ;_�[) <br />