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� <br /> APPLICATIO� FOR CONSTRIJCTIiMI PERMlT /���� �. ._� <br /> ` TO BE COMPLETED IN BLACK INK—PLEASE PRINT J <br /> �� HEATING SYSTEM: U GAS �ELECTPIC ❑_� 'L��'+�y7 � <br /> DUILDING DEP.ARTMENT <br /> 259-8810 <br /> �r �q DEMOLITION COMBINATION BUILDING �(MECHANICAL PLUMBING SIGN <br /> �i� OWNER MtdL A[IDRESS LITY ZIP PIIOM1E <br /> 9� y TENANT M�I��DOR[55 ��Y 'P P�E q�Z�j/ <br /> y ��,, � s i,���� Zsir� (�l b„/—�A,,� - ��� 1.t <br /> x , �' <br /> H x � Aq�HIiCGT OR LSiGNER MAII RDDRE55 qiY / ZiP PNONE <br /> FC n <br /> H �I <br /> � �' � GLN' TRPCTOR � ������ADpPE55 CITV ZIP P��ON[ SiAi[LICE�b[• <br /> V] N q <br /> � �� MEGUNIGALCONL C OIl MRIL�D PE55 l � CITV ZiP PNG11E STATELICCYE• <br /> y ����� ����� ��,��v.�d��, 9s�D�6 ��yo����.���E�� <br /> O �"� �IU�IBINGCONiHACT0f1 MAIL�ODRG55 CiiV 2iP I�MONE SiniEUC[NSE� <br /> ��g <br /> �` n cussorwoaK ' <br /> H <br /> x y� � ��. NEW ADDITION . �� ALTE9ATION REPAIR � DEMOLITIDN � WOODSTOVE�FRPL INSERT 9UILDING RELOCATI <br /> � H H �-1-/� L O�O cor+r�nc�s�nr�o allor+e No <br /> ty y CONTRACi PRiCE OF WOPN ���D�� , <br /> a H DESCRiCEWORNANO50UPREfOOtAGEIN:DLVED <br /> l� <br /> ���� . Lete.n� � M�r�.1c111_idrt —I11�V . E "1 _ -- <br /> � rao�ouseoFaunoT I HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED 1HIS � <br /> N J 6 qC L APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT.PLL <br /> y �� LEGFl0E5CNIPt10NOFi'RCCRTv�SM wNoe�awoanrmcHFovewPies� PROVISIONS OF LAWS AND ORDINANCES GGVERNING"fHIS TYPE OF <br /> 'L WOfiK WILL BE COMPLETED WITH WHETHER SPECIFIED NEREIN OR <br /> ,o,pZ�_ a��K 66 oF �•�--��r NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOHITY TO VIOLAT[ OF CANCEI THE Pf�OVISIONS OF ANY <br /> OTHEF?TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERPORx1ANCE OF CCNSTRUCTION l HAT I AM AUTHORIZED OV THE <br /> OWNER OF TMS PROPER7Y TO P[RFORM l4E WORK FOR N.'HICH � <br /> ;�PPLICATION IS MAOE AND 1 COMPU' WITH THE STATE <br /> CONT CT RS lAW � .P W AN�296200 WAC. <br /> 't ^ � o.;t.�7� <br /> aeaecT nooness °' "" /2� S��, <br /> �51/O Colb,v� ' ��� � <br /> fir+ =S514CIIAV� I���• <br /> ..--, PLUMBII!u' � MECHANICAL .�. ,L� <br /> f� , N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE � �;. <br /> �. WAT[R CLOSET(TOILET) A�C—A:HNDLG UNITS—H.P. , ti&,.' .!;�� �. <br /> i � BATHTUB FORCED AIR SYSTEMS—B.T.U. M LA. . - ::�, <br /> 1 ' LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �� .�� � � <br /> ��. SHOWER CLOTHES DRYERS ' p ,.��x'�dy�' <br /> � ��I KITCHEN SINK 8 DISP ; VEN7ILATION FAN , � • +�"��� ='i <br /> i RANGEHOOD - ����•;�� �� <br /> ; DISHWASHER � , . ' � <br /> LAUNDRV TfiAY WATER HEATER , <br /> .T <br /> I � CLOTHES WASHER WOOD STOVE , . � ��,�,.,' � <br /> � ' ' '� UriINAL METAL FIREPLACE 8 CHIMNEY �.. <br /> � FIREPLACE INSEFT ± ' <br /> DRINKING FOUNTAIN �,t`� I <br /> FLOOfl DRAIN HEAT PUMP _ ^ - <br /> BACKFLOW PREVENTERS i GAS PIPING � �ly� . <br /> . I +1 ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' ��+ <br /> � ' <br /> � � SIPIK�SERVICE—BAR,ETC.) ; �i <br /> � <br /> � `.�, <br /> � � ; . � _ <br /> ' _.1 1 ; := �. ' <br /> � SU0 TOTAL 5 -� +� <br /> SUB TOTAL 5 � •��' ` <br /> PERMIT $ PERMIT 5 '��";�� . <br /> I q ' , <br /> � TOTAL FEE $ TOTAL FEE $ � ,x'; <br /> 1 <br /> FOR OFFICE USE ONLY: <br /> FqONiS[t�ACH FEARS[TOACK SIOESETBACN PIRNCNECKNO ER fCE RLCEIPTNO. , _ , <br /> ���0 <br /> usezorve LOTAflEA VRCANTSITE FEES VALUATION FEE <br /> BUILDING <br /> tYPEUfLONIS.ALLOW�BLE tYPEOFCON51.At➢IAl occu�pn Nnaovrtwxcu4n5 <br /> PLUMBING <br /> SIZEOFBLIXl. r10.OFSTORIE9 BASEMENT MECHANICAI / �G <br /> OGWPANCYLORb FIRESPRHKLENSREOD MEIGHTIIMITATI�IJ ADDITIONALPLANCNECK � <br /> SPRINNLER <br /> T <br /> REASpN FOP SPRINKLERS <br /> S7AiE BUILDING SURCHARGE <br /> INTAKEBY PLRNSAPPROV[OOY CITYOFEVERETT PUBLICWORKS <br /> LOCRL SALES ; �-.- <br /> TAX COOE IS 3105 TaTA� ���L��J <br />