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APPLICATIO''� FOR CONSTRUCT�"'`N PERMIT � <br /> � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> Fti <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS O ELECTRIG �.l _ <br /> 259•8810 <br /> I� DEMOLITION Ll COM8INATION �BUILDING I I MECHANICAL I PWMBING (.1 SIGN <br /> MVNER M�iI�DOR[55 Clrv 2iP PHONE <br /> ?f}E BoEin/G r�o. , � o. 6or. 370� � M�s oF-�G ..SEflTL�, Ny. 9Si2.u_ 2GL-?sG3 <br /> TEN�Ni MAIL ADDRE CITV ZIP PNpYE <br /> Sl��' �T OL.iN67L <br /> �RCNIECTOROE516NER M�R�UDRESS GITv IiP PNONE <br /> ��C CNOl,J(«Il5 <br /> 'JEN'_R�L CONTR�GTOR M�IL�OORESS CITV ZIP PNONF. SUTE IICFNSE� <br /> �L.tTG�{6R, /�'/D�STL�AL— <br /> MECH�NIG0.Cd/TR�CTOR M�IL�DOFESS CITv 2iP VHONE ST�TE LIGENSE� <br /> PLUMBINO CONTRi1GTOR MA!l�DORESS C TY iIP PNONE STRE LICENSE� <br /> CONTq�CT PRICE Of W011K <br /> 20, oeo � . <br /> DESCRIBE WORK�NO SIX1�PE fOOTAOE INVOLVED CONUCi PERSON�ND PHONE NO �:Ei° <br /> `S,. <br /> LEoNg�� �}57"EMaORSK I 2GG—?SL3 � <br /> --__. I HEREBV CERTIFY THAT I HAVE HEAD AND E%AMINED THIS <br /> PIIOPOSED USE OF BUKCINO APPLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � � <br /> C/LLiJ SL�/L7'S2 PflOVIStONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE Of - �� <br /> IEUQOE6CRIPTIONOFPHOFEPTY�SNOWNBFIOWON�ttALNTWOGOPIE51 WORH WILL BE COMPLETED WITH WHETHER SPEGFIED HER[IN OR <br /> iot eior.K ov NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE - <br /> � AUTHORITY TO VIOLA'E OR CANCEL THE PROVISIONS OF ANV <br /> --���j� ��,.Q�I'�M1_��/}'//ij� ___ _ OTHER STATE OR IOCAL LAW REGULA?ING CONSTRUCTION OH THE . <br /> �'"Ff`b —'`�` PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OKNEF OF THIS PRUPERiV TO PERFORM THE WORK FOR WHICH <br /> ---- ------ APPLiGATION IS MADE AND 1 COMPLV WITH TME STATE <br /> P�RCE�T�M I D NUMBEF CONTRACTORS LAW 1827 RCW AND 296.200 WAC <br /> CONSTRUCTIONLO�NIENDER.�DDRE55.TELEPNONENUMBER �� / `.�'�Cf , // ,f/r�� '�. <br /> 1 I / P <br /> ��.�.�.��. <br /> PROJECTADDIIE88 : �iun� n+�E <br /> 3eo� Gv. G,o-s��o ,e . ys—�sr ��,.�z»�,s�KF�s�� <br /> pLUTAlINU MECHANICAL <br /> N0. TYPE OF fl%TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A�HNDLG UNITS—H P. , <br /> BATHTU9 _ FORCED A�R SVSTEMS—B.TL. M EA. _ I <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER _i CLOTHES ORYERS I <br /> KITCHEN SINK 6 DISP VENTILATION FAN I, <br /> DISt{WASHER RANGE HOOD <br /> UUNDFV �HAV WP.TER HEATER <br /> CLOTHES WASHF:R WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUFNING) <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSERT ; <br />, FLOOH ORAIN HEAT PUMP <br /> @ACKFLOW PREVENTERS GAS PIPING ' <br /> ROOF DRAINS—HAINIEADERS EXHAUST FAN —� <br /> SINK(SERVICE—BAR,ETC.) ' <br /> -- ' ' � <br /> , <br /> — — •� <br /> ` SUB TOTAL E SUB TOTAL S ' II <br /> PERMIT S PERMIT § i .. <br /> TOTAL FEE S TOTAL FEE 5 '� <br /> FOR OFFICF:USE ONLY: <br /> FRONT6ETBACK REARSETB�Ck SIDFSETB�CN F�ANLMEf,NNUMBER fEE RECEIViNp <br /> �/ <br /> USE 10NE l0T�PE� V�C�NT SIiE FELS VALUATION FEE <br /> fl '(GS fl NO BVILDING � <br /> U OJJ <br /> TVPf Oi CONSi, NO OF 6TORiE6 xcw•M'• Mn d owtumcuins — � <br /> � �� � '"�j° PLUMBING �_ <br /> 52EOFBlIXi fIRESPRINNLERSRFO'� OASEMENi MFCHANICAL � <br /> y .7 � �fv D ' YES ' NO - --- <br /> OGCUPANCVLO D FIREGL�RMREOD RE1fNTlIMIT�TION ADDITIONALPUNCHECN � I <br /> �q � <br /> /� • OTHER � I <br /> PE�SON <br /> STATE 9UILDING SURCN�RGE � <br /> INT�ItEBv PIANS PROVEDev CITYOFEVERETT PUBLICWORKS ' ' <br /> -�— LOCAL SALES <br /> o,,,E � . �� ,g 1 TAX CODE IS 3105 Tora <br />