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.�PPLICATION FOR CONSTRUCTION PERMIT � <br /> TO BE COMPI.ETED IN BLACK INK—FLEASE PHINT <br /> BUILDING DEPARTMENT HEA"fING SYSTEM. �]GAS U ELECTRIC V --------1 <br /> 259-�810 <br /> f 1 DEMOLITION I I COMBINATION I i 6UILDING MECHANICAL xPLUM0ING I i SIGN <br /> OWNER M41L��DRESS Ci1Y IIP PMOflE U <br /> �G'�/.I'G ��L'�-L��'f-Ei// ' Ci"7 �G'c'.Z-'L'7T nb�ZDS� TiJ Z�' / <br /> TENANT MML�O�RE55 CITY zlP <br /> PHONE <br /> �RCHITECTOROESIGNEP q�ILRO�RESS �ITY IIP PHONE <br /> fENER�LCONiN�GTOR M�II�D�RESS CIiV 21P PHONE SUTEIICENSE� <br /> MECH�NIL�L CONTRAG70R MMI.�ODHESS CIiY ZIP PMONE Si�TE LICENSE t <br /> U.Vi��E=�<�T✓.>"t�C.v.V��i'�NL /.�fIOiL'-/?/�d 5�1?2�c= �b/33 "�L'- 9� D �.U/i- �s,e,�zy��r9 <br /> �UMBINGCIXJiR�C�T l MMLADDPE55 Cliv 71P PHONE StA1El10ENSE� <br /> i C/ _ <br /> CON �CT PPoCE OF WORK — <br /> DESGRIBEWOP �N �REFOOUOIN✓ VEO CONT�LTPERONANDPHONENO <br /> �/�����"'��,.��,�� _ r����r�-- �GS�'Pf'Od <br /> � HEFEBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> raoroseouseorevaoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> ,�O/c�� �L/1Dr/� ��O� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEOALDESCR:PTN)NOFPqOPERiY�SHOWNBELOWOR�TT�CNTWOCOPIES� WORK WILL 8E COMPLETED WITH WHETHER SPECIFIE�HEREIN OR <br /> lOT — BtOCN ov — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OP CANCEL THE PROVISIONS Of ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR�2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFOFM THE WORK FOR WHICH <br /> P�RCELTAX�D.NUMBFR — APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> CONSTRUCTHJNLO�NIENDER ADORESS TEIEPHONFNUMBEP <br /> •�,�- /�=L(��- <br /> PROJECT ADORESS ��� s�n �� o+rc <br /> G (i l IIi iS Nl i51 iCl��Sf� <br /> 1'1UM81NG MECNANICAL <br /> NO. TYPE OF FIKTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATFR CLOSET�TOILET) A�C—A�HNDLG UNITS—H.P <br /> BA?HTUB FORCED AIR SVSTEMS—B.T.U. M [.A. <br /> LAVA70RV(WASH BASIN) — UNIT HE/7ERS—B.T.U. M � <br /> SHOWER CLOL IES DF 'ERS —r— <br /> KITCHEN SINH 8 DISP I VENTILA�:ION FAN <br /> DISHWASHER RANGE NOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> UfiINAL � METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN — FIREPLACE INSERT <br /> FLOOR DRAIN � � HEAT PU�1P <br /> BACKFLOW PREVENTERS — GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS ExHAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) � �.. <br /> � <br /> --�— � <br /> SUB TOTAL ;. � SUB TOTAL E <br /> PERMIT y PERMIT � <br /> TOTALFEE $ �' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN R[AqSETB�CK SIpfSFTARCM PIRNCHECNNUMPER !EF RELEIPLNO <br /> usezone LOT�RE� V�C�NTSrtE FEES VALUATION FEE <br /> �-� YES � NO BUILDING <br /> tYi'E Of LONS� NO OF S70RiE5 occuv�ur. so oi rtxii i�xc uxns --- -- . _ _. _ <br /> 4afnio <br /> PL11M81NG <br /> SREOFAIOG FlRESPPIN;LEPSRE00 B�SEMENi MECHANICAL � <br /> :-�, YES " NO -- _ <br /> OCCUP�NCYIC�D FlqE�URMREOD HFIOHTLIIAIi�TION ADDITIONALPLANCHECN <br /> nE�SON — -- OTNER � <br /> STATE BWLDINd SURGMARGE <br /> INTAKEBY P�ANS�PPROVEOB� CITYOFEVERETT rueucwoaKs � <br /> � � LOCAL SALES <br /> on.e TAX CDDE 13 3105 TOTAI <br />