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APPLICATIO''� FOR CONSTRUCTI'�N1 PERMIT � <br /> TO BE COMPLETED IN BLA�.K INK—PLEASE PRI�JI ev�err <br /> �� <br /> _ _ - - -- — - — ---- — - _� <br /> BUILDING DEPARTMENT �EATWG SYSTEM_ J GAS J ELECTRIC 17=u0N� ______ __ _J <br /> 259-8810 <br /> DFMOLITION COMBINATION �BUILD:NG MECHANICAL PLUMBING SIGN <br /> oWNER � ��ni: nc':yl,. ___ ....-_- _. .. _.___.. _ .. . .`:'_—'_ nuUnt _____ <br /> T7f-E (�o��v�--c� . P.o. (���,r ��707 M �s, �K-iG J�n--Z.� wA 9�li.y zG.6 -3.I'G � <br /> �[NnAt Mn npi�nf ti5 -� -- -__ - -- -- —J— -- <br /> cnr 1�v rr�onF <br /> �4+r7 6 /?S otNN�N <br /> enrHrtEcr pq p[s�GNFn IAUL�nORE55 �iry l�p -- p��0��� <br /> �/�4 �J�.i.1-��w��ST �N� �n�L � • PR 6���51�oKA"��u.tA__Scc�i �14` �S� <br /> �—�---J—— <br /> ��d r�E nAI CONiRACi09 MAIL POpR[55 Gitv 2�n nq��qf SiAIE LIGENSE� <br /> _-_ _ _..____'" ".-_ _ . <br /> _ .__.'_-_ _ ____' __ ._.' -._..-_- <br /> 4(l+�4NIC�LCONtPn('i0�+ AIr111 �0�RE55 ;,ilv lin Y��UNI S1A1flIGENSE� <br /> �iul�pWGCONTPAf.iOR iA4i1 PODR[SS CITv 2iP �JNE S:4EliCEN1E• I <br /> f CYiqAfi PqICf Of Wp�K "—' - <br /> LS , CCo <br /> IHSCRIAEWORN�NDcniun[[mi��:c�NVIXVEO --- " CONUC't[R':ON4qOPNpryENO �- <br /> -- —,— 9 n =.f" ---- <br /> - - --- -- <br /> 0 <br /> 7�tn.,f;GK STUP-n aC ( Sc�nif�rt{� TSTCT : �Qn/(S/� l 2C4 -3-1'(, � <br /> - -- ------ ------- - - -------- <br /> — --.-- i HEREB'I CERTIFV THA1 I HqVE READ AND E%AMINED THIS <br /> ���°���o>couse ovom�onic APPLICATiON AND KNOW THE SAME TO DE TRUE AND CORRECT.ALL <br /> %hC l. S Td�t_,r�+.� _ PROVISIONS GF LAW3 AND ORDINANCES GOVERNING THIS T'/PE OF <br /> .�����n :�cscnivTronoFvnovemv�sNowrveeiowoaaTucHrwocoriEs WORK WILL BE COMPLEiED WITH WNETHER SPECIFIED HEREIN OR <br /> ,;,r _ B1C,�K �F ___, ______ NOT THE GRANTING OF A PERMIT OOES NOi PRESUME 70 GNE <br /> - AUTHORI7V TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -�� � � ---- PERFORMANCE OF CONSiRUCT10N. THAT I AM AUTHOR12E0 BV THF <br /> OWNER OF THIS PROPERTV 10 PERFORM THE WORK FOR WHICH <br /> �nar,e�r�eio r�uMe[n <br /> �- � -� APPUCATION IS MADE AND I COMPLV WITH TH[ STATE <br /> CONTRACTORS LAW 182i HCW AND 296200 WAC <br /> . . __ '_ --_ _____ <br /> �.o��srnucnor��um��e�+oia nonnea•-ru;w�o��eNuuorn / n �- � <br /> - - - --�- - ------�-- y-/�J��,�..�f ��`*-��, A�y�y� <br /> PROJECT ADDRESS "`�����-----�- ----�--- - -n,�� ---- <br /> 'x�o 3 � c.A,�,.�o RD �i�'� -JrJj -,.�. s.,,�. - — ---- --- — - --- <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF "P,!iJRE OR ITEM fEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSf:T '�'.ILE f� A-C--A i1NDLG UNIiS-�H P. ; <br /> -._ - . .-_.. . ._.____ . .__ _ . - ___' ___ _ _ _-__-_.-_ _---___.._- .. ___.--.-_ <br /> ___ BATHTUB FORCED AIH SVSIEMS-B TU M f- A � <br /> - ____ _____ ._-_ .- . __:_ ._ __ _.. --___ _.__..--._-__. <br /> . ____ __. _ ..__�_- <br /> LAVATORV(WASH�A514 _ _ ' UNIT�I[ATERS-E3 T.0 M ' <br /> _. . ____- _. .. _ _ -____-___._ _._.___- _-____._-_- . ' <br /> SHOWER CLOTHES DRVFRS � <br /> __-._ __.. .._. _--.__- - � <br /> _ KITCHEN SINK 8 DISP VENTII ATION FAN - <br /> -_ _ _-- — __- ' <br /> . ___ _.___ _ __- __ <br /> DISNtNASHER RANGE HOOD --T <br /> I.AUNDRV TRA1' WATER HEATER - <br /> CLOiH[S WASHf_F! WOOU SiOVE � <br /> URINAL _ METAL FIRFPLACE (WOOD BURNING) <br /> _ DRINKING FOUN:"AIN _ _ ' � FIREPLACE INSEfiT <br /> _ FLOOR�qhlN HEAT PUMP <br /> BACKFL04V PREV,iNTERS � GAS PIPING <br /> _.. -___-___ _____.______ ___ '__. __. -_.__—____- _ _ ' . <br /> _ ROJFDRAINS-RAWLEADERS � EXHAUSTFAN <br /> _ SINK�SERVICE-BA9,ETC,) <br /> - --------- - --------T-- -- --- --- - <br /> -- -- - ��------ -----�---L-- - ----- <br /> �— - -------- ----- --- --- —�— <br /> SUE�TOT4L $ ' SU6 TOiAL $ � <br /> ___-. ._.._-__- __—__-_..__.--___ .____-__._. ____ __ _. ____ _______.._______.__-_ __.__ <br /> P[RUIT 5 � PERMIT $ , <br /> _.__- ._. . ._ _ ___ ..__-___.__ __._.__ . _ _ . ___ -__. . __-__ . _.___.______-_-__ <br /> TOiAL FEE 5 - � '.OlAL FEE $ �- <br /> FOR OFFICE USE ONLY: <br /> -- <br /> �nuNr SF�P.tr. r nt nn SI t(IDt. _"__�� Sil�( til tOnLn ni e� ���E':h N,'L9c�1 <br /> /- �11 nFrF��4J <br /> �%,�7(�l� <br /> _--.._.___ ' _____-__._ . -______--__... . . -_ <br /> iisFiu��e iotnnEn vncnr��siir FEfd$ VALUATION FEE <br /> � VES NO ���i��iN� <br /> tmEortONS� . NooiSTONiES an-...r. •�, rni,.���.����- . . ___.- __.__ _._ . .. .__..______... _. ___.__��-�_____ <br /> �L <br /> � ` � ��r�� � r'� JIdBIIJG � <br /> _.__ _ _-'�__ � - _'—____- ' -"-____ ___"' -- _- I__. <br /> sVEO�NtW RqF.SPNiHNLER5RE0�� BlSEMFNi MF.CI�.,�NICAI � <br /> 9�o spf i NJ rts � ' <br /> _._ -- ___ _ _- ------ -- <br /> ---� ------ p <br /> OCCU��NCYLO�D fiRERURAIPFO[' HUGIITL'I..�'�Oh-�-�-�' A�DRIONAIPIANCHECN _ �f O'.�u <br /> Z ,�, ------- <br /> __.._--- - — <br /> -_ _- --_-___"_-'_.__ __ __ __ . .. _ . Uin[R � <br /> �EASON � ._ ._ _."-_— __-.—_ __ _ <br /> r _ <br /> ItlntE FUILDINGSURCH4ROE .! ; /� <br /> _________'-. ___ _._ ___ .. , <br /> -_-"' - _-_ _ ' �___ <br /> ��nn.vev ; r,n�,se ���rvti�i�. '� CITYOFEVERETT aunucwoRKs ' <br /> A1'� LOCAL SALES <br /> u�n' !�. i', 9j � TA%CODEIS3105 1orn� � ��� <br />