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APPLI�ATI�"�1 FOR CON�TRUCT��N PERMIT � <br /> TO BE �OMPLETED IN BLACK INK--PLEleSE PRINT <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: ❑GAS p ELEC7RIC U ,_ <br /> J <br /> 259-8810 l'7�/,'?�: ;C�� '?�'Dt� <br /> I � DEMOLITIUN i i COMBINATION I 1 BUILDING I I MECHANICAL �PLUMBING I I SIGN <br /> pWt![p IAa1lADDRE55 CpY D^ PHONE <br /> t�v�r���ic�E �bs�,�bJ -� �' �------ �� �ss ��Z3 <br /> TENANI /_r„ _AA/ MR�I.DDNE55 /�n, nN��f�jY QJ�i R3.�\ <br /> C3Cl�IL/V'IC.. L Lw Ul� C�i(L f[.Vc���.1 <br /> 1 <br /> ANLMIiECTOR�E5IGNER IAN�ADDRESS Glty✓`� 21P PNJNE <br /> �fOTt�Slfj A�G$l1 d //�_�ZOG /fD4? E c r} 98203 2� Z5'9 � <br /> GEIERRLLONiRAL10R UnIIADDRE55 CRY IIP PIICYE S7�iEUCENSE� <br /> n1EW41►WJ �t�5 nZUGTr.N <br /> MECNANIC��C"„ W/�iiE55 ^ � �T %"/�/Ki��[ TD�I� 3�73� � STA�IL.ryS�I—�K� <br /> E <br /> �v� Fi �-�! <br /> PWMBINGCGNIRACrpq MpI�AUOtiE;S pTY ZIP PNONB SiP1EUGENSE� <br /> D��to�v/J 8 /�d6�fl�G l�tb,c �8 /3�!/r !�y 9� �187�36m DiN,�c�pl,rX4 <br /> CONTR�CT PRICE OF WORK <br /> �r hf�2, 3l.�-73�J� <br /> DESCRIBE WORK ANO SOURRE FObTAGE INVOIVED GONtACT PERSON 4N0 PNONE NO <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaovoseo usr or emioiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL AlL <br /> PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGRL�ESCN�PI�ONOFPROPER7Y�SI/OWNBELOWONAi1ACNTWUGOPIES� WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT�NG OF A PERMIT DOES NOT PqESUME TO GIVE <br /> ior eiocK oc AUTHORIiV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHEF STATE OR LOCAL LAV�'REGULATING CONSTRUCTION OR THE <br /> PERFOPMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER GF THIS PROPERTV TO PERFORM THE WURK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PARCEL T�%I D NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> GONSTRUCi10N LOAN IENDER.ADORE55.�i EIEPHONE NUMBER <br /> X ` /� ��� '��.9- <br /> PROJECT ADDRESS 3m��A+une 8� --�- ���� <br /> c�rv yus�yf s51�cP�;F rv] <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM PEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH CLOSET(TOILET) AiC—A�HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR;YSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M _� <br /> SHOWER ' CLOTHES DRYEFlS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRV TRAV ; WATEF HEATER <br /> CLOTHES WASHER � WOOD STOVE � _ <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPIACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTEHS GAS PIPING ; <br /> ROC�F DRAINS—RAINIEADERS EXHAUST FAN <br /> SINK(SERV�CE—BAR,ETC.) ; � <br /> � <br /> � <br /> — � <br /> I � <br /> SUBTOTAL $ ;00 SUBTOTAL $ <br /> PERMIT $ �� PERMIT $ _ <br /> TOTALFEE $ ' TOTAIFEE $ <br /> FOR OFFICE USE ONIY: <br /> fRCHTSETB�GH FEARSEIBACN SIDESETBnG`t PLANCHECI�NUMBEP FEE HECEIPTNO. <br /> � / <br /> usezoNe �oranen VRGPNi51TE FEES VAIUATION FEE <br /> ❑ YES ❑ NO BU!LDING � <br /> IVPEOfCON51. NOAPS70NIE5 oCtUr�xtv r.ndOw[wM,uxrtS i <br /> GB� PLUMBING i <br /> _ � <br /> SIZEOFALUG. FIRESPRINNLEFSREOD BASEMENI MECNANILAL <br /> o ves ❑ No — � <br /> OCCUPANGVIO�U FlNEAURMREOD NEIGHi1.IM1iATION <br /> ADCIiIONAL PLAN CHECH i <br /> _ ' <br /> OTIi[R � <br /> REASON --� <br /> STAiE UUILDING SURCHARGE � <br /> i <br /> IHTr1HE0V rinrv;nvrnovenrr CITYOFEVERETT PU�LICNOtiHS � <br /> LOCIIL SALES <br /> onn; TAX CODE IS 3105 TOTAL � <br />