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APPLICATIO!' FOR CONSTRUCTI' �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMF_NT HEATING SVSTEM: J GAS ;.1 ELECTRIC J � <br /> 259•&810 <br /> DEMOUTION COMBINATION �4!BUILDING MECHANICAL PLUMBING SIGN <br /> 01Vr1ER 4�iL AOORk55 CiiV DP aHCNE <br /> ,(�o�'in,s Co. f� o. l�c�c 3� 0� , �5 off-i? SSq�rL� wA • 4�°�Ly 3`/�--�339 <br /> TENANi .qiLPppPE55 Cliv � IiF � PIIONE --.. <br /> �OL/N6 • <br /> ♦RCNIiEC10R0E51GNFR !�niLADDRE55 �ITY zio PMONE � <br /> �.N�/� � i <br /> GENERA�CONiPACiCP I,UI��DDRE55 �ITV $IP FNONE SiRtE L�CENSE� <br /> �usiC626�AI MnB�I� <br /> ���ECMANiWICON�R�CT04 AULLADONE55 Ci1V piP PHONE STREIiCENSE� <br /> PLUA�Bi�IGCONTRGLIOR 1.U�L�t`JRE55 pTv ZIP PHONE STRiELiCENSE� <br /> GONLR�LTVRi�EOFWOPH '' �� M — ---- <br /> O <br /> DESCRIBE Y/ORN nND SOU�RE i00inGE iNVC:VED LONTACT PENSON�NDPHONE NO <br /> Looi►-1'c T,G,g�L�c � Lcso�vsti�� /,�sTE,u13o2skr 26s.-3tL� <br /> G'ONS%2�GT �}p10�N� �CK i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PAOPOSED USE Of 0l➢IDING APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIOPIS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGQ�ESCRioiiONO�PROPERTviSHOWNBELOWOR�Ti�CNTWpCOPiE51 WORK WILL BE COMPLETED WITH WHETHEq SPECIFIED HEREIN OR <br /> �ot—_ BiaK aF __ NOT. THE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING GONSTRUCTION OR THE <br /> — PERFORAIANCE OF COIJSTRUCTION.THAT I AM AUTHORIZED 8�THE <br /> OWNER OF THIS PRCPERTV TO PERFORM THE WORK FOR Vv' iICH <br /> vance�in�ior+u�.�een APPLICATION IS MADE AND I COMPLV WITH THE ST, TE <br /> CONTRACTORS LAW 1827 FCW AND 296.200 4YAC. <br />� coNslnucriohlOnNIENOEn �o0�F55 tEIEP��nNF.NUA�prR � � <br /> y�aw.""'�'t�' � / 9�— <br /> PROJECT ADD ESS sa i��nc - ����� --- <br />� 3003 �. c.es,No ,CD. 5!.c�—�s�/ �,.A„s„�ss,�E,.��,,, <br /> PLUMBING MECHANICAL <br /> iNO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET�TOILET) NC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) UNIT HEATERS—BS.U. M <br /> _ SHOWER CLOTHESDRVERS �— <br /> KITCHEN SINM 8 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAV WATER HEATEF <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE (N�OOD BUFNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> T <br /> SUB TOiAL 5 SUB TOTAL $ <br /> PERMIT $ PEFMIT 5 <br /> TOTAL FEE $ TOTAL FEE $ <br /> FnR OFFICE USE ONLY: <br /> 4RO�:TScT a[K RE4RSEIBACN Si�ESETBACK P�pNCI�E xNUMB�IE�Rn FEE RELEinTNO <br /> J I��� <br /> use zor�e ior aaee yaCANT SITE FEES VALUATION FEE <br /> .� VES —. NO BUILDING <br /> rvPE O�C045L NO OF STORIES ec[.s.�,c. rq m ownoneur,�5 _i <br /> r=. <br /> PLUMOING <br /> ;iZEOiBLOG FIRESPRiNKIEASNEOU B/SEMENT MECHFNICAL <br /> � � VES �� NO — � <br /> OGCUPAN�v�p�p qRE RUnrA RFOD HEiO��T UMrteflON ADDITIONAL PLAN CHECK <br /> OiHER <br /> pE�SON <br /> T— <br /> STA�E 9UILDING SURCHARGE <br /> uu.Env ruNs�PPaoveon� CITYOFEVERETT PUBL�CWORKS <br /> LOCALSALES <br /> DALE TAX COUE IS 3105 Torn� <br />