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; APPLICATION FOR CONSTRUCTION PERMIT <br />. TO BE�PLETED IN BLACK INK—PLEASE PR� � <br /> BUILDING DEPARTMENT I HEATING SYS7EM: IJ GAS IJ ElECT171C IJ � <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING �l MECHANICAL 1 I PLUMBING I I SIGN <br /> owNen '------------ <br /> I.U�I�UO�EFS . _____ ___-___ __ " ___ <br /> C�Iv lll• --'- PIKNJE -- <br /> .���-( C12ouP �cv7�,7Z- <br /> 1EN�Nf __'-__-" _-_'_. __'-__' . . ._......'_-_.__ <br /> M�tl.�UUOFFS f11 V ]IP PIIONE --" <br />� Tt,L�K 'S LaFF�E� E� EvErtEr�.�lu-rv��. �1' - �` <br /> nnc�mecronoes�cuen unn.nnnness � -- �--�" � --'--- � <br /> ❑Ilv 711`-"_-_-- .. _.-PIkINE • <br /> ______'_" . ___�_-__.'__'_____' <br /> QFNEMLCONIIIACipR IAnry.Appl1f.55 GIIv �p� � � PIInNf: 91�IELM.fNSE� <br /> i — <br />��I �ECN�NICMC nClpq MAIL�DDItESS f,liv plP I91(„!E S1�lEl�GEN5E1 <br />� P.►z+e�o�c-�in.E <br /> I, PR.e�vcT..�� 2ao4-.� �1a''kLr.cr.�, T..�w. q8424 C2o�)92>.zzgo P[aTQtF?o99GF' <br /> j PIUMBM6CON111�C10� IAMI.AflllpfSS ------- --GIV _---_-' ZIP I'110NF C1�IELH;ENSE� <br /> i' <br /> CONIMci PNCE Of 140RK y p - <br /> I � `'70� . ^ _ _.. <br /> �E9Cf110E WOPN ANOSOU11t1E fW1AGE INVOLVEO Cq1��Ci pF1150N�NU 1`IlnllE IlD. <br /> Ex�-+o Ews�rwG.� SP¢...�k��, — <br /> '�r�-","`� �a�2sa- �20� 72.�- 2Z90 <br /> i�iore�T�.,, -rp �1�ew S4-��So. �T.-- --- ---� <br /> -S'EN�+-��. <br /> ' rnovoseovseorguaorc:e7 . — � HERFBY CERIIFY 7HAT 1 HAVE READ AN� EXAMINED TNIS <br /> APPUCATION AND KNOW THE SAME TO BE THUE AND CORf�ECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> iKcnto¢scnirimNorrnoremr�,iwwNnei.rnvonmincutwocorie.^.� WOfiK WILL BE CqMPLF1FD WIiN WIIF7}IER SPECIFIED HERF.IN OR <br /> � �or etocK or NOT. TH[ GRANtING QF A PERMIT UOES NOT PAESUME Tb GIVE <br /> ' AUTHORITV TO VIOIME OR CANCEL THE PROVISIONS OF ANV <br /> --�--- --- .._.___. . <br /> O7HER STATE Ofl LOCAL LAW qFGULATING CONSTRUCTION OR THE <br /> --� �-�� -�� `--- PERI°01161ANCE Or CONSTRUC710N. 'IHAT I AM AU7HORIZED BY Tflf <br /> OWNER OF THIS PfiOPERTV TO PERFORM THE WORK FOR WIiICH i <br /> rnnce�inxin.r�uueEn ---"- --'----�- ��'�'UCATION IS MADE AND I COMPLV WITH THE STATE <br /> cUNiRAr,IORS lAW 10.27 RCW ANU 296.200 WAC. <br /> CONfiiIlUC110N Ip�NLF.NpEII.�bbRF.SS,Ifl FPIIOHF.HIIMpFf1 � <br /> PROJECT ADDRESS '---�--�--�--...._ X�`�1�_ !c�""`.-r I� 'I 8• 9 S <br /> c , nnrtrc -"___ ---__ '�ie�E - <br /> - f,ilY PURM�SS IXpi:C Ix�-- <br /> PLUMBINQ MECIiANICAL <br /> N0. TYPE OF Fll(TURE OA ITEM FEE N0. TYPE OF EOUIPMENT� FEE <br /> WATER CLOSET(TOILET) _ � NC-I1/I�INUIG UNI1S-H.P. <br /> � <br /> BATHTUB � fORCED 111f7 SVSTEMS-B.T.U. M E.A. � <br /> _ LAVATORY(WASN BASIN) —�_ _ UNIT HEATERS� B.T.U. M � <br /> SHOWER � CLO7HGSUf1VER5 �— <br /> KITCHEN SINK 8 DISP i VEMILAI ION FAN i— <br /> DISHWASHER -��—� 17ANGE HOOD � <br /> � IAUNDRYTPAV �— '_. <br /> GLOTHES WASIIER ' W�TER I IEATEfl � <br /> � � WOODSfOV[ � <br /> i <br /> URINAL ' METAL FlRcPLACE(WOOD BUfiNING) � <br /> DRINKING FOUNTAIN --�—± fIREPL�CE INSERT � <br /> FI.00R�RAIN , — ' <br /> � HEA7 PUMP � <br /> BACKFLOW RREVENTERS � GAS PIPING � � <br /> ROOF DRAINS-RAMLEADERS � E%HAUST FAN �— <br /> _ _ <br /> � SINK(SERVICE-BAR,ETC.) � i — - -�— <br /> _�_ � <br /> � _ � -� � <br /> -'— — ' <br /> � �,— <br /> � <br /> �_ <br /> i � <br /> --+— _ i <br /> � <br /> i <br /> , SUB TOTAL S � SUB TOTAL S � <br /> _ PERMI7 S ---� PEfiMli S � <br /> , TOTALFEE a TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRditSETB�CK qEntI5Et0�CK S�I�SElOACN • PL�NCIIECH 11 FO fEf: f1ECEIPTNO. <br /> �3 ,� <br /> usezor+e Lotnnen vnr.nNrsnE F ES VALUATION FEE <br /> ' 1.1 VES Il'NO <br /> • � .BUILbIN6 . � <br /> TVPFOff.ONSL NO.OPSIOnIfS pN��� ry�MM.,ti���Mi�iR . <br /> r�P�' � PlUM01NO � <br /> i <br /> � <br /> SIZEOFOl00. FlItF.SVqINN�ER5nE0'U IIASFMF.IlI ' ��- �-- <br /> I-1 VES 1-1 NO M�CIIANICAL � <br /> OCCUPAl1CVL04D fIBE�L4NAitE011 aEiGntuunnn0l� �DDI710NAlPLANC�IECK } <br /> � <br /> REA90N "'__ OIIIC'R - ^- _-_ � iO�- <br /> � <br /> � _ S1ATF�UILUINGSUt1CHnRCE � <br /> iuinNenr ninusnkTnovrunv CITYOfEVERETT ruoi.icwonKs ; -' <br /> ��� LOCAL SALES � <br /> on,e �p_�6 _s� TAX CODE IS 3105 rotn� � a � � <br /> � ��- / !�� . <br />