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APPLICATIQ'` FOR CONSTRUCT''�N PERMIT G� <br /> TO BE COMPLETED IN BLACK !NK—PLEASE PRINT " •�nv4•rr <br /> `�,, <br /> HEATII�ii SYSTEM: �]GAS ❑EIECTRIC J — I <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I i DEMOLITION � ', COMBiNATION I 1 BUlLDING I 1 NlEC4ANICAL Cl PLUMBING SIGN <br /> OWNE� / /� MAiy�AODR[SS GiY jiP PHONE <br /> S/cdf dC�/ �r�7r /�v �+ ,t SZG> �•x��7Y S�ZGG� S"z6) 2Sf- Y35'�— <br /> iENANi � AfAILAUDRES; C GIiY ZIP PHONE <br /> nF G LC S C1/J il ,�C+ �r Cd ��q i��.�Dl+- _ - <br /> APLNIi[GTORDESIGNEA MAILADDRES$ CITY ZIP PHON[ <br /> GENERALCONTPACTOII MAILADORESS CIN 21P PIIONE STATELIGENSEs <br /> IAECNANICAL CONTPAGTOR MAI�ADDRESS CITV ZIP PMONE S�A7E UCENSE N <br /> PWMBINGCONIR�CTOR M/.IIADDRESS GITV ZtP PIION[ STAiEI�GENSEr <br /> Q�� �/� M ,5� � s �� Z /�-� n S�� f� ay� ���-,�z3� ,¢.e�i-iz�,¢.� <br /> CONiFAGTPRICE0FIVOFK � <br /> �S o v J "' -- <br /> DESCRIBE WORK AND SOUAflE FOOTAGE INVGIVFU GONT�GT PF[1��1N nNp P�ONE N0, „� /�C <br /> eT �� <br /> / ���� "_____ <br /> I HEREBY CERTIPY 1'HAT I HAVE READ AND EXAMINED TH!S <br /> PROPOSED USE OF�UILDING � APPLICATION AND KNOW THE SAME TO BE TFUE AND CORREGT. ALL <br /> (1 �� ��t.,✓p�c ( PRCVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYFE OP <br /> LEGALOESCBIPTIONOFPROPERTVISHOWNBELOWOFdTTPGHTWOCOPIES� WORK WILL �E COMPLETED WITH WHETHER SPECIFIFD HERFIN Cf7 <br /> ,`JOT. THE GRANTING Or' A PERMIT �OES NOT PRESUME TO GIV[ <br /> lOT— BLOCN oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS O� f fJ1' <br /> DTHER STATE OP LOCAL I.AW REGULATING CONSTFiUCTION Ola TNF <br /> — P_HFORMANCE OF CONSTRUCTION.THAT I A�d AUTHORIZED L"! 1HE <br /> OJJNER OF THIS PROPERTY TO PERfORM THE WORK FOR 1'JHICIi <br /> APPLICATION IS MADE AtJD I COMPLY WITH THE :��TAT[ <br /> PARCEL TA%I.O.NUMBER CONTRACTORS lAW 1827 FC\N AND 296200 WAC. <br /> CONSiRUCT10N LOAN lENOER.AODRE55.TELEPIIONE NUTABER � 9�\ / j J��'C U � ���r / <br /> x <br /> V (/.� <br /> PROJECTADDRESS � � ry s��,Ne*unc �"�� _ <br /> 2oZj �,�� 4L /Z d�/' curn.isnussuccnsrrvo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUlPMENT F�E <br /> Wp1EHGLOSET(TOILET) � A/C—A'HNDLGUNITS—H.P. _ __ <br /> PATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. _ <br /> L.4VATURY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> ^HOWER _�_ CLOTHESORYERS . <br /> F:I;CHEN SINK 8 DISP I VEN7ILATION FAN _ <br /> DISHWASHER � RANGE HOOD <br /> � LAUNDRY TR�Y _ _ WATER HEATER i__ <br /> CLOTHES N'45HER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUfiNING) ' _ <br /> DRINKIN('.FO'.'N' IN FIREPLACE INSERT _ <br /> FlOOr GRAII� � HEAT PUMP <br /> BACNFLOv'J PFEVFNTERS GAS PIPING _ <br /> ROOF DRi+I�JS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.� I -`— <br /> ' — <br /> SUB TOTAL S � '� ' SUB TOTAL S __ <br /> PERMIT S ,9i1 � PE(7MIT $ _ <br /> TOTAL FEE S =.. ; TOTAL FEE 5 ' — <br /> FOR OFFICE USE ONLY: _ — <br /> PRONi5ET8ACN P[ABSETOAGK SIDESETBACK �IANCMLCNNIlldp[P �' fHE RECEIPTNO. <br /> l_�! )i� <br /> usezoNe LOTARER vncnNrsire L FEES VAWATION FEE <br /> :li YES : � NO BWLOING <br /> IVPEOFlONST NOOFSTORIES ouurauc h0o�ox'nl�4�inin6 - — <br /> cuorr PLU1dBING � � � i'�:� ` <br /> SIZ[OFBLDG. FIPESPRINNIERSREO'D BASEMENT MECHANIC�L // ��� <br /> ❑ ves ❑ No — - - - <br /> OCCUPANGY.OAO FlRE�IARMREO� HEIGIITI.IlAIiATION AD�ITIONALPLANCMECK __ <br /> OTHER <br /> I�E.4SON <br /> STATE OUILDING SURCHAIiGF � <br /> INIANEBY FinN;nPrivovecr� CITYOFEVERETT PU6LICWORKS <br /> LOCAL SALES <br /> �,,,� TAX CODE IS 31Q5 TOTA� <br />