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,:� <br /> APPLICAT�JN FOR CCINSTRUG . ION PERMIT ,� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ���T � <br /> I <br /> i HEATING SYSTEM: ❑GAS U ELECTRIC ❑ � I <br /> BU�LD'NG DEPARTMENT <br /> 259-6310 � <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN I <br /> ^yp�Eq UPIL�GDRE55 Litt ZIP PHONE , <br /> �� .S ; �.-�uR�,�or� u+�,�T s� ��'�l� � � 3��z -r ��..,�Y 3aa� ('� <br /> iCVANI MAIL�DOflESS � G�iY 21P PMONE <br /> ARCHREGTORUESKaNCR MMAD�flE55 CITY 21F PHONE <br /> �in� GENERALLOIJTR�GTOR MAILAD(WESS CITY Z'P PHONE STATELICENSE• <br /> .o�x `�c�3��u GoNSi' 1.l3t h�lNr..Ar�o �Jr�l� �ti1�.+'R�,3' zSi-)vSo /Vi}C/S9C� Z3aCh <br /> �' H M1ILCNIWIGN.Ca11R�GTOR MRRIIDDRESS CT' ZiP PHONE STRTEIiCENSE• <br /> ayti <br /> H z H PLUMBMGCONTqACTOF MAILADDRE55 cm � zro PNONE StATElKENS[/ � <br /> .� n <br /> H x7 cuss oF wa+K <br /> ';1 �"1'T� � NEW � ADDITION . : ALTERATION !XREPA�R I 1 DEMOUTION I '� WOODSTOVE/FRPL INSERT i BUILDING RELOCATION <br /> H.T. y t~" <br /> �� CONT�CT PERSON RND PNONE NO. <br /> (s� Q CONTRaGTPNIGEOFWORK � SJ �� <br /> O H d DESGRIBE WORK AND SOURRE FOOTOGE INVOLVED � <br /> r�i t��.g s��,�L1�6�'n`�tS� ;rsro.-- v�rr� S�o�,ct — <br /> aaoPos�ouseoFem�oir+c i HEREBY CERiIFV THAT I HAVE REA� .4ND E%AMINED THIS <br /> H� G L�,��� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> z H 3 P(;�VISIONS OF LAWS AND ORDINANC[S GOVERNING THIS TVPE OF <br /> 9 HCi7 LEGALDESCRiPT10NOFPROPEiiTY�1�5110YM�El'riYORARACNFWRGOPIES� <br /> r H H io* �y ��IG e�ocK /L� oc WORK WILL BE COMPLETED WITH WFIETHER SPEGFIED HEREIN OR <br /> _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUIdE TO GIVE <br /> ����yyy y p AUTHORITY TO VIOLATE OR CANCEL TNE PFOVISIONS OF ANV <br /> Cy U. I ✓� j O r ��'��� f- OTHEF STATE OFi LOCAL LAW REGULATING CONSTRl1CT10N OR THE <br /> � Q r PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> :; HfA APPLICATION IS MADE AN� I CO'dPLV WITH THE STATE , <br /> y C'� CONTRACTORS LAW 18.27 RCW AND 29G200 WAC. <br /> 3�3� �B' --Q� X �i��i/� � -//—`!\ <br /> r�naecr nnoaess ""'- � <br /> o.,� <br /> 33n=- 1cc� � L31 Goc Y •� � ,,, -- – <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> ��"""'� WATER CLOSET(TOILET� A C—A�HNDLG UNITS—H P <br /> ' BATHTUB FORCED AIP SYSTEMS—B.T.U_M E.A. <br /> LAVATORY 1WASH BASIN) UNIT HEATERS—B.T.U. M i <br /> � <br /> SHOWER CLOiHESDFYERS ' <br /> �`I KITCNEN SINK 8 DISP VENTILATION FAN <br /> DISHWASNER RANGE HOOD <br /> LAUNDRVTRAV WATERHEATER <br /> �" `�' CLOTHES WASHEF WOODSTOV[ <br /> ""� URINAL METAL FIREP�ACE 8 CHIMNEV , <br /> DRINKING POUNTAIN FIREPLACE INSERT � <br /> � FLOOR DRAIN HEAT PUMP , <br /> �,.,rl I BACKFLOW PRE4ENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXIIAUSi FAN <br /> SINK iSERVICE—�AR,ETC.1 <br /> ��� � <br /> „�� SUB TOTAL $ SUB TOTAL S � �k�� <br /> P[RMIT $ PERtd1T S <br /> IOTALFEE $ ' TOTALFEE $ �! <br /> FOR OFFICE USE ONLY: <br /> FBJNTSEiI1hCY, qEPR5ET0AGN S��ESETBACN PLANCNECKNJlIMO[R / «E H[CEIPiNO ' <br /> ) / I� <br /> usezone �ornae� vetu+tSirE FEES VALUA710N FEE <br /> BUILDING !�n j 7�� � � G�U . <br /> tYPEOiCON15.AlLOW�BtE ttPEO�CONSTACiUAL oCcuHlcCv Mo.uUw[u�xcvnrs � � <br /> �a� � PLUM9ING <br /> SREOFBlIX3. NO.OF6TORIEB BlSEMENT MECHANICAL ' <br /> OCCUPANGYlO�� FIRESPRNNLEFSREOD NEIGNTLIMITATION <br /> A�DITIONAL PIAN CMECK i <br /> SPHINKLEH <br /> NUSON FON SPRiNNlERS <br /> STATE BUILDM�SURCHAFiG[ � �f��J <br /> rt�rnreer rut+snaPaoveoev CITYOFEVERETT PUBLICWORKS <br /> LOCRL SAIES <br /> TAX CODE IS 3105 rorn� ,],��� ;c���, <br />