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APPLICATIO� FOR CONSTRUCTL �N PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: [�GAS IJ ELECTRIC I,� _ _ _ __I <br /> 1 <br /> 259-8810 <br /> i i DEMOUTION COMBINATION BUILDING MECHANICAL �PLUMBING SIGN <br /> owrve� uui nnoi�[ss — <br /> 1 ��� urv tm m�oue <br /> �Qf�LT s�Q.�fIC.E�s 'P.O. E�(37r11 SFr�4 kll� `1817l�1 <br /> TENAHI MAIIA�PRCSS cnr zm r�io�ie � <br /> ANQII�p SIGNGR IANIADOflEuS -- SAME� _ <br /> CIIV lll' PIIONE <br /> MANu1M �. Noa-DFoiZs Z9o�. — 3� �1rT '�Jr.1 Si�A�� WA • <br /> GEN[IULGONiMCTON MMlAOIlItE55 GIIV LIP PIION[ Si�fEIILENSC� <br /> /� i ew1 ns�1 �(a►r�1L �.o,_�oZ� F�Fii�l� I�/A �I•881� <br /> MECIUNiGALCONIRAGTGB YAR�00fif."a5 CItY IiP P11pNE SiRCLICEN5E1 <br /> � k Y G�. �Pb P..tx 2�1�51�7 ��,_qg12� 7G2•3311 M N'YJ'LNo <br /> PLUMDINGCONTRACTOR M�il�0URE55 , GiY 11P V110NE $TAIELICCNSE/ <br /> _�4Mfa. � <br /> ci ssocwoen -- <br /> NEW ! I ADDITION I I ALTERATION � I qEpqiq � i DEMOLiTION � �. WppDSTOVE/FRPL INFiERT � I BUILDING RELOCATION <br /> MEc'HNdIC�V- iZ�090�D00 LONi�GTPER50NANOP110HEN0 ��•w' �•�yyg <br /> corvrnncrrn�ceoFwonK GpJ41Ca EMFILIC.►� [yO,µl� T b D <br /> D[SCf110EWORNAND50UMCF00IAfif.INVOLVED µE� ����N� _ �yNy �p.41 : HtEaH BAY TrtST" �1REA (��pooR�-� <br /> �NO .4�1s�.��+ 3 9�otY oGr-� �A � ) tlRunot �.�.sr sL� <br /> rnoroseouseovowioiNo I HER BV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> I�I�I FlJL91pIFIcLAIU L� APPLICATION AND KNOW THE SAME TO BE TRIIE AND CORRECT.ALL <br /> LE6AL D[SCIiIPTpN OF VROPEIITV�5110NTI OELOW 011�tTACH iWfl COPI[5) PROVISIONS OF LAWS AND ORDINANCES GOV[RNING THIS TYPE OF <br /> �or �aK � IYGAK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE <br /> AUTHOAITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEPFORMANCE OF CONSTRUC710N.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM TI1E WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTFACTORS LAW 1827 HCW AND 296200 WAC. <br /> PPQIECiADDRE55 9�.� W wr ���µ' x � �•�•�I <br /> P+F .�a�.f7 ,rru�urt u�q <br /> I�IO e1B2y5 — �2:ntL� <br /> CIIYpIKNlSSIY.IMSL NI <br /> PLUMBIN(i MECHANICAL <br /> NO. TYPE OF FII(TURE OR ITEM PEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC-NHNOLG UNITS-H.P. <br /> BATHTUB FORCEDAIRSYSTEMS-B.T.U. M E.A. �— <br /> �§ LAVATORV(WASH BASIN� I OS � - UNIT NEATERS-�.T.U. M <br /> 'j., SHOWER - CLOTHES DRYERS --r— <br /> KITCHEN SINK 8 DISP ; VF.NTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDflV TRAV ' WATER HEAiER <br /> CLOTHES WASHER —�- WOODSiOVL —� <br /> URINAL ; - METAI FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN Z� � - FIREPLACE INSERT <br /> �:� FLOOR DRAIN q � � - HEAT PUMP <br /> 2 OACKFLOW PREVENTERS � - GAS PIPING <br /> K HOOF DRAINS-RAINLEADERS � ��, � - E%HAUST FAN -�— <br /> SINK(SERVICE-BAR,E7C.) �- <br /> 21 - <br /> � T <br /> - T <br /> SUB70TAL E ; — SUB TOTAL 5 <br /> P[HMIT $ � � PERMIT $ <br /> TOTALFEE S � TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONi5El0ACK REAPSE70ACR SIDESH70ACN PLANCII[CNNUMOE�N/ FCF IICLUPiNO <br /> usezone �oru�[e vncnrasire FEE� / VALUATION FEE <br /> OUILDING <br /> IYYE Of GOf1I5.�LIOWABI[ IYIK Of COH51 ALIOAI uxuwcr Nn�x vaAliw.�MuS <br /> r.nwr pLUMBING <br /> G12[OV uLDG. No.Of StON[5 IIASEMCNI MGCHANICAI <br /> OGCUPANGVLOAU FlNCSPONhI[NSOEO'D IIFIGIITLIMITn110N ADUI�IONALPLANCHECK ! <br /> SPRINHIER <br /> nusoN ron srwNHiins <br /> - ------i-- <br /> STATG�111LDING Sl1RCHARGE � <br /> iNrnxcur rwisnrrnovconr CITYOFEVERETT ruoucwoRKs � <br /> LOCALSALES <br /> __ TA%C DE IS 3105 70TAL <br />