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APPLICATIO. . FOR CONSTRUCTt 'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PIEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: i,.]GAS U ELECTRIC ;J <br /> 259•8810 <br /> DEMOLITION ! � COMBINATION I ' BUILDING I i MECHANICAL I 1 pLUMBING ! 1 SIGN <br /> OWNER MAI DfiESS CITV Z�P PHONE <br /> ,E,�Ai??��.��- �D l.� 52�7 �v�rcr_rr wa ��n/ s�•y�3s�f <br /> ���A IdAILADOR[55 C�TV :IP PHGHE <br /> �— pLAu� �uErz�rrr w,a <br /> ARCHRECi OR DEStGNER MAIL PDORE$$ GTV IIP �'����7 �Z3•�S D� Tr <br /> L���SICIj�..�.)/.��tiJC PO i'�t��C 1oZ �IZr'�/�1C3��W��/- . � • � ��" <br /> GCNERALCONTRAGTOR MAILFO�RE55 GITv 2iP PHONE SiAiEUG[NS[b <br /> �C�LI?�L.�'OA�si IZ �.U�Q.I��r" <br /> M[GHANiC4LCONTPACTOR IdAiLADDFE55 CITV ZIP NNONE SiATELILENSE/ <br /> PLUMBINGCONTRACTOR MAIIADDRE55 CITV 21P PNONE SThTELICENSEII <br /> GONTIUCi PRICE OF WORK �) <br /> J''� OG�V � <br /> 0 CPIBE WOR D SOOARE FOOTAGE INVOLVED WNiPGT PE ON AND PY �E NO <br /> � I�D V��' T 'Y��AI� �� .�T. '1-U iZ_Q.S �lGi '�ca-uU,c�l,c.a6 • i4i7��-F <br /> � 3 2a SQ FT', 3Z3 -�3�Od <br /> i HER[BV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF OU�LOING APPLICpTION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �ST/�UR.l�\'1 PFOVISIONS OF IAWS AND ORDINANCES GOVERN'NG THIS TYPE OF <br /> LEG�LDESGRiPTIONOFPROPERT�VIS/H0I/YNBEIOWORATTALHTYOWPIES� WORt WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT� s�ocK–�� oF �''4T OF ���t� NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE . <br /> �UTHORITY TO VIOLATE OFl CANCEI THE PROVISIONS OF ANV <br /> OTFI STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PEI r0 MA OF CONSTRUCTION.THAT I AM AUTHORI2ED BV THE <br /> O JNER O T�IS PR PERT TO PERFORM THE WORK FOR WHICH <br /> A�PLIGA IQN I AD ANO I COMPLY WITH THE STATE <br /> PARCEL TAf(I D.NUMBE(i --��i NTRI� RS L iB RCW AND 296.200 WAC. <br /> - (�-1 - 0p ^ � 0060 <br /> CONSTRUCTION LOAN LENOEH.ADDRESS.TELEPMONE NUMBER � <br /> PROJECT ADDRESS =,'+ �+ ���� <br /> I � y E �,� A�, ,E ,��ti - <br /> PLUMBING EC AN CA <br /> NO. TYPE OF FIXTURE OR ITEM FE NO. TV OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A'C A/H UNITS—H,P. � <br /> ——�— <br /> BATHTUB FORCED AIR YSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWE-R � CLOTHE�ORYEPS �— <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRVTRAY WATER HEATEfl <br /> CIOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING fOUNT�IN FIREPLACE INSERT ; <br /> — —T <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKfLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERF � FXHAUST FAN <br /> SINK(SERVICE—BAR,ETG) ; <br /> � <br /> SUB TOIAL 5 ; SUB TOTAL $ <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE S TOTALFEE 3 � <br /> FOR OFFICE IfSE ONLY: <br /> FFONTSGT�ACK REAq5E78ACK SiDESGiBACK PLANGNEGNNO�� FEC nq RECEIp�NO � / <br /> ��L� 7L / � <br /> uselorve �ornaen vncnrvTsire FEES VALUATION FEE <br /> f . YES :-! NO BUILDING '7�J �GlJ � � f 1� <br /> TYPEOfCONSi NOAFSTORIES ofa=av[+ �:oormttun:cw�rts �� <br /> i <br /> -m I � ""�° � PLUMBIN6 <br /> _��.Iv � <br /> SIZEOFBIDG. Fiq[SPFiNKt[PSREO'U BFSEldENT M[CHANICAL � <br /> I(�7 �� T • /1.1� �. .' VES �NO ; <br /> OCCUPANCVlOAD FIqEALAFIAREOD NBGHiLI1dIiATION ADDITIONALPLANCNECK i <br /> 2� �� I OTH[fi <br /> i <br /> R[ASON �� <br /> STAT[BUILDING SURCHARGE i/ ; ')i) <br /> � <br /> iNmKeov rinr�snrvnaveoov CIlYOFEVERETT PU�LICWOPKS <br /> �IN1 'OCAL SALES T— <br /> oree (p j� e� TAX CODE IS 3105 TOTAL � ���u� <br />