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APPLICATION FOR CONSTRUC710N �ERMIT <br /> CITY OF FVEf1ETT• BUILDING DIVISION � <br /> 320D CEDAR STRE67• [VFRETf, WA 98201 •259-8810 <br /> T•I. <br /> I I DEMOLITION I I COMBINATION BUILDING ❑ MECHANICAt I I PLUMBING I I SIGN <br /> PROJECT ADDRESS 21�� �-I�Y AYErIUE , �yE't�E f'[', V�d��-Vll�,'Tpt,j <br /> ownrn n�nn nnunesc cnr zm PIIONE <br /> rP_l�_EVEgE'fi No•3,It.�. 27�11 CcuSYAVE,�liB.EVF.E�1T,�q82n1 2�i-?�t`f8 <br /> �rnnnr emn nunnras �:irr --- nr - ruour- <br /> TKI�"�aNE�I�A FtN.GJdlLi II'jOS.oUVE�, hp('fE 1�3p� (,OSfJYitltSU\�f?�IS 2�3-?42-�-22 <br /> nncmirr.ionuesir,rmn e.mnnuunrss- --env zm ruor�e <br /> �QN��.d7K/.►�+�k!_AZ, �fiToKlQZp�fJZ �,�'1lTTl,E�k7A,`ISlol 2`12-frz&3 <br /> ❑FNfI1�LCOt1i011C1Of1-" —MM�.�b1�11f55 -- (:IIY '— — ZIP PIIUNf: SIATELICENSEr <br /> '�IV��ERC.oI�.�'�(�1UNCv. (oDt Vu10195'C.SEAT'(LE� I,i,�•qP�fo( bZ3•I`[8� 7'u��lK�c.237c2 <br /> MffI1�NIC�LCONIf1�ClOf1 MnILAIIb(IF.55 f.��Y 71P CIIONE S7ATEUCENSE� <br /> PIIIIAflIN�f,@lIf1ACIIX1 6�nI1.AUUnE55 CIIY ZIP PI10NE STATEUCENSE� <br /> COIIII1nCi Pf11f,E Of WppN <br /> �,i�DOD•Qp __ HEATING SYSTEM: �QGAS I�ELECTRIC ❑ <br /> bE5CI11BEWOfBANb5011AtIF.fU07�t3E1NVOlVEO rrnitncrrenso �N�PII011fN0 <br /> ---- -----.�ILL_�ONES <br /> _I,ZGb 5Q• FT• 4FFfcE'fE1.��.1�T luf'RvrE- �JpN�sT�k�AtU li.�, ?_�t2-a283 <br /> N��Cj �R� ���'��� Q� �}2, �' I I1ERE8Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnoroseo use ov eunoir�� — APPLICATiON AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PRUVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ienniuesr.mrun��orrnorrnrvisiwwrrneiowaq�nn�ncn�wocorms� NOL TNE ORAWTIN6 OF A PERMIT DOES NOT PHESUME TO GIVE <br /> to� ��mocK�G_��or-Lkt�T GF EVE�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> i/ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> OL H 3 O �J r c�f� 32 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOPIZE� BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnnr,ei inz i u r�uMnen CONTRACTORS L 8. 7 RCW AND 296200 WAC. <br /> cou��' „�NE.UTr�'o�N11A1flEfi p.� n <br /> � v u X (/•4� �o <br /> ��_�.�__ siu unE onre <br /> CIIV BUSMESS UCENSE NO. <br /> PLUMBINO MECHANICAL <br /> NO. TYPE UF FIX'fUfiE OR ITEM FEE NO. TYPE OF FI%TURE OR ITEM FEE <br /> WA?EH CLUSET(101LET) --i /VC-AMNDLG UNITS-H.P. � <br /> — —'- <br /> BATHfUB ; FORCEDAIRSYSTEMS-B.T.U. M E.A. ' <br /> LAVAiORY�WASH OASIN) --i HEAT PUMP —� <br /> — � <br /> 5li0WER � UNITHEATEFlS-B.T.U. M � <br /> KItCHEN S�NK 8 DISP i` CLOTFIES DRVERS ' <br /> _ � <br /> DIShIWASIiER �� VENiILATION FAN � <br /> LAUNORY iRAY � RANGE HO00 � <br /> � <br /> _ CLOTHES WASHER i— WATEH HEATER —T- <br /> URINAL ; WOOJ STOVE � <br /> ORINKINO FOUNTAIN i METAL FIREPLACE(WOOD OURNING) { <br /> FLOOR bRAIN � FIREPLACE INSERT(WOOD BUFNING) � <br /> � L_� <br /> BACI(FLCW Pf1EV[NTERS ; �AS FIREPLACE ' <br /> _ � <br /> SINK(SEf1VICE-DAR,ETC.) i- GAS FANGE �— <br /> ' GAS PIPING � <br /> �' — <br /> � EXHAUSTFAN � <br /> �—— —.— <br /> i � <br /> � , <br /> — --- � — � <br /> i— ' <br /> SU�TOTAL $ ' SUB TOTAL S ' <br /> i <br /> PERMIT $ , PERMIT $ �r- <br /> —'--- <br /> TOiALFEE $ � TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> ftlONf5F.l0�CR fiF.�tlSElp�f,N SIbESEf0l1CK p1�NCIlECNNUMOFp FEF qECEIPTNO. <br /> C��173 /l�s�s �a19s�3 <br /> use ior+F �ot ntu�n VnCANi fiI1F. FEES VALUATION FEE <br /> nrr:s n ru> nmiuiva Qi �'J <br /> ueirur uMnnnou no.ur uwn.ur�n s¢c or nuron i — <br /> urais ��DG� I•/• riuraoir�o -� <br /> an�U�ANCY IIO Of 51f11UF5 OCf:11PANi IOAU P�SEMENI 61ECIIANIC�L i <br /> �_ / /_�..__—/ //. YES 11 Np -- � <br /> fIf1ERl�I11A1iE00 fiP�50fl -- �bIN��011ALPLANCIIECK � <br /> t�.� i <br /> ��l Gi4'�/• oiiien �— <br /> nnr:srnn�kiFnnmu --- nFnsor� — <br /> i <br /> �9�f � (� SIAlEOUIIbINO511nC11l�OGE ; <br /> L_'.__._�__ __ <br /> irrForcousr rinnsnrr1jc:veoev CITYOFEVERETT ruoucwonKs � <br /> ��Y� LOCAL SALES - � <br /> __�� __ un�[ �'�_ _ TAX CODi IS 3105 TOTAL _ __ � <br /> - — _� <br />