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... ... .�.. <br /> APPLICATIO^ FOR CONSTRI�'CTI"N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTti1ENT HEATING SYSTEM: i]GAS U ELECTRtC ❑ <br /> 259-8810 <br /> DEMOLITION COMBINATION �BUILDING I IMECHANICAL I PLUMBING SIGN <br /> pWryEP 6��RqPORE55 /CITV 21P PMONE <br /> ,(�pE/r.�s Co, f� 0. �a� 3107 , /�`/S o/f-/?, ScCA�!'Cd L✓A • 9�°�iy 3'/Z--7339 <br /> � <br /> TE�UNT All ADONE55 GiTv ZiP PIICNE <br /> /�D(��/N 6 • <br /> ARGNiTECTLP�ESiGNER NAilA00RE55 CiTV IiP PHONE <br /> i (.le�:'� <br /> GEhEPnL60NTR�LtOR 4UtLAD�NESS GiV 21P VMONE STA/EUCENSE� <br /> ���1� �� ' /�_ � � _ _ <br /> MEGHANI��LLONTR�CTOA MUL�DDRE55 Citv 2ii PNONE ST�iEULENSE� <br /> PLi11.1BINGLONTRFGTCR MAR�DORL55 CitV 2�P PHONE cLnlEIiCENSE� <br /> CC�ITR�Gi PRIGE C�WUAN <br /> �s i� <br /> ____'_'�.���.__ ___. . . _- _. ..__- . _ . . . _ . _ . . __._.. _ _ . __ __ ._ . . . .. <br /> UCSCf1il1E WQIIN�NO SOUM�L!t%]I�f,l iiN(RVL❑ nnNim.l PI.Imu114N0 P�u ML NU <br /> ��( C �' /� .i i. . '"Y� � :C i�.. <br /> Lcsd�v.►ti�� /�sT�M.13o�ski 2�6r3sG� <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raowee:u-�F or eui,owc APPLICATION AND NNOW THE SAME TO BG TRUE AND CORRECT.ALL . �,� <br /> t���-�=i :_t.< PROVISIONS OF LAWS AND ORDINANCES OOVERNIN6 THIS TVFE OF _ .. <br /> �EpALDESCRi>Ti040FPR0>ENTV15HpWNBELOWOFQT�CNTWOCOPIE51 WOFlK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIV OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME T(` GIVE <br /> iot e�ocK or AUTHORITV TO VIOLATE OR CANCEI THE PROVISIONS OF ANV <br /> OTHER STATE GR IOCAI.LAW REGUL;dWC CONSTRUCTION OR TNE <br /> - PERFOR6IANCE OF CONSTRUCTION.TI�AT I AM AUTHORIZED BV THE <br /> OWNEH OF THIS PROPERTV TO PERFGRM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COM�'LY WITH THE STATE <br /> PFRCEL T�%1 D NUMBER CONTRACTORS LAW 10.27 RCW AND 296200 WAC. <br /> / l ' <br /> COhnTRUCTIONLCANLENDER.��DPE55.TELEPHONENUMBER <br /> Y � �� �'"%•�'„��r-�.�' e��/-�: J �� <br /> PROJECT ADD ESS / sK�u.m�e n�n <br /> goo3 W. c,�s,Na /LD� ��' � ���� Li'vpVSiM[SSULfNSfNp <br /> PLUMlINO M'CHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE7) A�C—AMNOLG UNI75—H.P. _ <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M ___ <br /> SHO'NER CLOTHFS DRVEFS <br /> KITCFIEN SINN 8 DISP VENTILATION FAN <br /> DISiiWASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CLOTHES WASHEH WOODSTOVE <br /> URINAL METAL FIf7EPLACE(WOOD BURNING) <br /> URINKING FOUNTAI�J i FIREPLACE INSERT <br /> FLOGR DRAIN � HEAT PUMP <br /> BACKFLOW PR[VENTERS ; GAS PIPING <br />� ROOF DRAINS—HAWLEADERS F%HAUST FAN <br />' SINK(SERVICE—BAR,ETC.) <br /> SUBTOTAL $ SUBTOTAL 5 <br /> PERMIT S PERMIT $ <br /> TOTALFEE $ TOTALFEE E <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBnf.x REAR SETB�CN SIpE SEiB�GN PLAN CMECN NUMBER FEE �ECEiPi NO <br /> useioHe LOT�pE� VALAN75itE iEES VALUATION FEE <br /> �� VES � , NO BUILDiNG ��•"' <br /> rrvEQftOKsi NOOF�TORiES aao.wn xac�c+vnu+euxus — <br /> V� I •A°pPR PLUMBINu _ <br /> 1 /J �' <br /> SIIE OF BL FldE SPRiNItlENS AEO�� lIRSEMENT MECHANICAL <br /> 3 S T.1 .� N U - VES �-NO — <br /> OCCUPANCYLO�D ��qE�LARMREOD MEIGHTLiMiTpT10N AD�ITIONALPLl.NCMECK _ <br /> � N U CfHER � <br /> RE�SON --r— <br /> STATE BUILDING SUFCHARGE �� <br /> INTAKEBY PU�+S�, `VEDO� CITYOFEVERETT PU[ILICWOFNS � <br /> � � LOCAL SALES —T <br /> o.� _ a� _ �i� TpX CODE IS 3705 T0TI1L _ ' <br />