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APPLICATIC'� FOR CONSTRUC7"JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��T <br /> BUILDING UEPARTMENT HEATING SYSTCM: ❑GAS �.ELECTRIC J _ _J <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MAM1h0URE55 GITY ZIP PNONE <br /> C7 /�,,SD P-� Po BoK 6699 L��wood qso36 '77Y-oyv�f <br /> �jENANT MAM1 ADOFESS dry ZIP PNONE <br /> � rtw�in FF i7.ob:ra-�-{ Po (3ox 66-SI9 L nnwood y$o36 T74-oyy�/ <br /> ARCHR[GT OR OESIGNER MAIL ADDAESS GITV 21P PMONE <br /> Kovu�L./ovr-+-�� 74�S - �-Zz�.d SF SE �•.+ood.'nN/4 93�7.1 485-3538 <br /> GENERAL CONTRAGTpR M�IL RODRE55 CITY ZIP PHONE SUTE ULENSE l <br /> OJ/��r <br /> U[CHRNIC4l GONTRGLTOR MAIL ADDRESS CnI 21P PNONE STATE LICENSE• <br /> PLUMBINGCONTR�CTON MAIL�DDRESS GRV ZN PMONE STATELICENSEY <br /> LUSSOf WOFK <br /> NEW X ADDITION AITERAT10N REPAIR � DEMOLITION WOODSTOVE;FRPL INSERT BUILDING RELOCATION <br /> ��y� GONrTA1C�T.P[RSON A>Nd PHONE N�O) ...,-��J�y� <br /> CONTRACTPRICEOf WOPN 50 (/(/�/ 1 w'�ih FebIKIT -/-I'� " �„�� <br /> DESGRIB[WORN AND SOUA�iE FOOT GE INVOLVEU ,.L��Ci ����'ryf <br /> va�oa�ouseoFeu�i� d��M �o S � I HEREBY CERTIFY THAT I HAVE READ AN� EXAMINED THIS <br /> �t APPLICATION AP��, K�O�.. THE SAME TO BE TRUE AND GORREGT. ALL <br /> LEG . LSGFiPTIONOFPROPEAT�'ISHOWNOEIOWORATTRCNFOUPCOPIES) PROVISIUNSOFLAWS.WDORDINANCESGOVERNINGTHISNPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPEC��IED HEREIN OR <br /> ior BtocK oF NOT. TNE GRANTING OF A PERMIT DOES NOT PRES'IIdE TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> F�S I � Add � E�K� S3Ir OI� 1�-OD ' � OTHER STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> Le�' I LttT W IS F+ Fr G�b Jlua e� Lp� �1 OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHIGN <br /> Y APPLICATION IS MADE AfJD I COMPLY WITH TIiE STATE <br /> CONTRACTORS LAW 1827 RCW l�ND 296200 WAC. <br /> C.0 Ff F� cd6.� Av� 61e lo <br /> J y"Zy'9 Z <br /> PROJ[GT ADDRE55 .�%'�a""'� o��F <br /> 360� Go�6 ��,.P��.,�„�5�.��.�.�-.��,�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUAE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� A'C�A'HNDLG UNITS—H P. <br /> DATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UIJIT HEATERS—B.T.U. M _ <br /> SNOWER CLOTHES DRYERS _ ' <br /> KITCHEN SINK 6 DISP ; VENTILATION FAN _ I _ <br /> DISNWASHER i RANGE I100D <br /> LAUNDRV TRAY � WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN i FIREPLACE 1NSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING i <br /> ROOF DRAINS—RAINL[ADERS � EXHAUST FAN <br /> SINK(SERVICE—BAP.ETC.) i � <br /> — i <br /> � <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ --� PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ —�--- <br /> FOR OFFICE�SE ONLY: <br /> FFGNTSETBACK REARSFTBACK � SIOESGTB�GR PLANCHEGNNUTAB[R �EE NECEIPTNO <br /> � � /� � ,�.�u� ;+i �� R �3 �;��n <br /> us[mrue �oi naen VAGAN�T SiTE FEES VALUATION FEE <br /> .-1 60 X I ZJL.Z1 U gUILDING ��Qn` y/� ' '�_; <br /> 7v{'E Of CONiS RILOWABt[ 7YI'[Oi CON57.RG7UpL actuo�uP �+'i R�rv;uNnS � <br /> -1�, � � PLUMBING i <br /> -y.1 v <br /> "4EOfBlDG NOOFSTORIES BASEMENT MGGHANIGAL � <br /> 3�01 'T��A'T I '2 ND ��/� <br /> ��-�� AD�ITIONAL PLAN GH[CN � ,�j{-��7X "r,/(/ � <br /> OCGUPANGV LOAD FIFE SP1RNKLEFS REOD NEIGHT LIMITAT19N <br /> � I`��L� �„� i <br /> SPRINKLER ' <br /> _— —_—T <br /> REASON FOR SPPINNLERS <br /> STA1E BUIL�ING SUflCNARGE _ ' ��r�1 <br /> ir�rnKeev rinvsnrrnoveotiv CITYOFEVERETT PUBUCWORKS J� ;Oc� <br /> LOCAI.S11LES �� � ; ��� <br /> -�g�3 J� TAX CODE IS 3105 TOTAL <br />