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APPLICATIL�1 FOR CON�STRUC7 .dN PERMIT <br /> CITY OF [VERETT•D�1ILDING OIVISION � <br /> 3200 CEDAR STREET•EVEP,�=TT,WA 98201 •259•8810 <br /> f 1 DEMOLITION ( i COMBINATION � BUILDIN9 f i MECHANICAL f 1 PLUMBINO rl SIGN <br /> PROJECT ADDRESS <br /> 3eo3 1/�, cas�No rc.J 4�- 303 <br /> OMMEN MAIL�ODIlESd CITY ZIP PIIONF. <br /> �dE'�N6 cu . �oa 3�07 s o�,? S�,�rrc,[� w�zy 3Vz-733 9 <br /> 7ENRNT MN1.11WRF55 LI Y IIP PHONE <br /> (jAe .Nc <br /> �I1LII�RCTORpESIGNEN M�II.�O�f1E55 Clh' TIP PHONE <br /> Po6i�✓e- <br /> OENERALCONTMCTpi MAIL�WilE55 GiV 71P PIIONE $UIEUCENSE� <br /> �l.[�T'�lf�'r GE.v,E"A,?1. <br /> ME H�N����CONTRACTOfI M�II.�DDRE55 CIiV IIP PIIONE S7ATEUCENSL� <br /> ALUMBINOCONiRACTON M�II�ODRE55 CI�Y ZIP PHON6 Si�TELICENSE� <br /> CONiMCi PR�CE OF WOIiN <br /> `{'0 DOO HEATING SYSTEM: 1 I GAS rl ELECTRIC rl <br /> �ESCRIBE M/ORN�ND SOUME FOOUOF.INVOlVFO CONTACt PFNSON�NO PIIONE NO <br /> Msw �..�G, ayxs� L�n-�tin i9sn�Ba�ski �6�- W'L <br /> I HEREBV CER7IFV THAT I HAVE READ AND E%AMINED THIS <br /> vno SEO USE OF BUILpNO APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC?.ALL <br /> � r�$OX ����6. PROVISIONS OF LAWS AND ORDINANCES QOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPEC�FIED HEREIN OR <br /> LEGALOESCRIPTIONOFPROPERTV�SNOWNBELOWpi11T1ALNiWOCOPIE51 NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> ior BLQ:K or AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REOUTATIN(i CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> — OWNER OF THIS PROPEHTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> rencei ux i o r+uMaen CONTRACTORS LAW 1827 RCW�J AND 286200 WAC. <br /> CONSTRUCTI!YI L011N LENDER.�DMIE55.1ElEPHdIE NUMPEII x �' 'J • �%V�'/�� �/2��7� <br /> SIaN�tU D�TE <br /> CITV BUSWESSLICENSE NO <br /> PLUMBINO MECfiANICAL <br /> NO. TVPE OF fll(TURE OR ITEM FEE NO. TYPE OF fl%TURE OR ITEM FEE <br /> WATER CLOSET(TOILET) � A/C—AMNDLO UNITS—H.P. � <br /> BATHTUB ' FORCEDAIRSVSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) i HEAT PUMP � <br /> SHOWER � UNIT HEATERS--B.T.U. M ' <br /> KITCHEN SINK 8 DISP i CLOTHES URYERS i <br /> DISHWASHER � VENTILATION FAN ' <br /> LAUNDRYTRAV ; RANOE HOOD i <br /> CLOTHES WASHER � WATEFi HEATER � <br /> URINAL ' WOOD STOVE ' <br /> DRINKINa FOUNTAIN � METAL FIREPLACE(WOOD BURNINO) � <br /> FLOOR �RAIN � FIREPLACE INSERT(WOOD BURNINO) ' <br /> BACKFLOW PREVENTERS ; GASFIREPLACE � <br /> SINK(SERVICE—BAR,ETC.) � OAS RAN6E � <br /> � QAS PIPINO ' <br /> � EXHAUSTFAN � <br /> � ' <br /> i ' <br /> � ' <br /> —. —r <br /> i ' <br /> SUB TOTAL S ' SUB TOTAL S �_ <br /> PERMIT S � PERMIT E � <br /> TOTAL FEE E ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> iBONT SFTPACN I1EA0 SETP�CK SI�E SETB�CN PUN CNECN NUMAFR FGE RFCEIPT NO <br /> �J->> <br /> use zor+e LUi AqEA v�eervr srte FEF.S VALUATION FEE <br /> I1vE5 I1 NO BUIL�INO � } 3sJ � �� � <br /> � <br /> NEI6HT LIMIT�710N NO OF DWELLING SIlE Of BIWRI <br /> UNILS I 3 Qp PIUMPIN6 <br /> OCCIIPANCv Iq0�5i0RIE5 OCCUP�NI O�U B�SE4ENT MECIUNIC�L <br /> OROUP � <br /> � f1VE5 fWFO <br /> FIREIIU�MREO'� REI,SON �DO�iIONAIPL�NCMECN I��� <br /> � OlME� <br /> flRE SPRINKLF.R REC'D RE�SON <br /> / � , STATE BL'ILUINO SIIRCH�MIE ( <br /> 1 <br /> TYPEOFCONST PUNSAfPOVEDOY CITYOFEVERETT PUBIIf,WORNS <br /> V' � / M LOCALSALES <br /> � oere - ) S - 9 � TAK CODE IS 3105 TOTAL <br />