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QpPCICATI �OR CONSTRUC'�„ON PERMIT /;� <br /> TO BE�JMPLETED IN BLACK INK-PLEASE PRINT �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC f.7 II <br /> 259-8810 <br /> f_l DEMOLITION I I COMBINATION I I BUILDING �MECHANICAL 11 PLUMBING I_1 SIGN <br /> OWNfR unaenonrrs cnr zm r�rove <br /> �� �y.P(�1,Rr �x_��'ices VUPt�C 3"l0� ��r2e �nll�l •2?0� <br /> TEN�NT M�IL�DOf1F.S5 CIiV ZIP PHONE <br /> �xFiw_� ���PPr.�Qr ��R�'���5 �x3 Ca��nu ��.cus' _`� �t!y�y�f' <br /> encwtecronoesicNeA Meneooncss cnr zm rr�a+e <br /> OENEfUICONTRACfOR M�R�DOIiE55 CITv 21P PHONE STATEIICENSEI <br /> 1�'kF'W�I iuc Ic1� �r�i� A�,�� C �O�tR.c q�1�2, <br /> MECHNIIC�LCONfPACiOR MMIRODRESS Ci1V dIP 1•NpNF STATELICENSE/ <br /> 1�1Ck1l.l�7fR C � ,DQ 2?G ,��(�;J ;�l''l�iTLC � 1 Z IACJCIf.I-��,)��AIO <br /> PIUMOMOCONTMLiO MRIIBDURESS C�iY ZIP PIqNE SIATFLICENSE� <br /> CONTR�CT PRILE OF WORK . <br /> �lii� ��o <br /> OESCRI9E WORK�ND SIXU11E FOOIAGE INVOLVED�r COIIT�CT PERSON AND PHONE NO.MYVr-l� 'I�K)i�7I�� <br /> l <br /> ? �� � , <br /> I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> rnoroseo useoeounowc APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br />, GF -� PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG TH�S TVPE OF <br /> �ea��oescairTrono�rnoreqrvisHowNaeiowonnrT�cNTwocor�esi WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFiEIN OR <br /> NOT. THE GRANTING OF A PERMIT �OES NOT PRESUME TO GIVE <br /> ioT niocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br />�I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%ID.NUMBER APPLIC TION IS ty1ADE AND I COMPLY WITH TNE STATE <br /> CON A OFiS LAW���CW AND 296200 WAC. <br />� CONSTRIICTI0Nl0�NLENDEP.�UO�ESS.TEI[P110NENlIMOER ,) `/�/l,y n �}/ J <br /> x �'C�"`s � " �j'`� �/!(/ �/ <br /> PROJECTADDRES / �""�"'�"� ,(� o"'� � <br /> 1 �. �I /; �) Il(�� `-I�O CIIYIIi11�111111N:IMl1 M) .. <br /> LUM INO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET) A/C—NHNDLG UNITS—H.P. <br />� � BATHTUB FORCED AIF SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—D.T.U. M ; <br /> SHOWER ' CIOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENiILATION FAN • ; <br /> D�SHWASHER RANGE HOOD � <br /> � LAUNDRYTRAY ; WATER HEATER ; <br /> CLOTHES WASHER WOOD STOVE � <br /> UHINAL METAL FIREPLACE(WOOD BUFNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br />, � FLOOR DRAIN HEAT PUMP � <br /> BACKFLUW PPEVENTERS GAS PIPING ; <br /> ROOF ORAINS—RAINLEADERS �_ E%HAUST FAN � <br /> SINK(SERVICE—BAR,ET0.) <br /> � <br /> — i <br />' SUB TOTAL $ SUB TOTAL S ' <br /> PERMIT S PERMIT E <br /> TOTAL FEE E TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN RE�RSFTB�CN SIOESElOICN PLANCII[ NUMOE �F.E RECEIPiNO <br /> � '��-+� <br /> USEZONE iornnen WC�NTSRE FEES VALUATION FEE <br /> n ves 17 No nuaowa ' <br /> �rrcacoNsi. r+oasioniEs occw.�. x�a�m«�x�oxns , <br /> 0PO1v PLUMOMC � <br /> 512EOFOLDO. FIfiESPRINNLEfISREdD P�SEMFNi MECHANICAL 1 <br /> I�1 VES I I NO — , <br /> ocCUr�NcvloeD Finee�nnMnEo�o ��EMHruMirnnoN AODITIONALALANCHECH _ i <br /> i <br /> OTHEfI ' <br /> — � <br /> AE�SON — - T— <br /> S7ATE BUIlDINO SURCHARGE i <br /> � <br /> wuKcnv rieNsnrrnovennv CITYOFEVERETT runucwonKs ' <br /> LOCAL SALES � <br /> oq,F TAX COOE IS 3105 TaTA� <br />