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APPLI(CATIC l FOR CONSTRUCT'��N P�RMIT � <br /> TO BE CO�dPLETED IN BLACK INK—PLEASE PRINT �� <br /> ' HEATING SYSTEId: �GAS J ELEGTRIC J ___ . ___� <br /> EUILDING DEPARTL4ENT <br /> 259 8870 <br /> DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING X SIGN <br /> ,—r.� ,` f/ MAiI/�DOaEGS � GTv Z�� n,.p•;� <br /> �'C ./C7A'MINOH6' }SG/h-Ls CLPl��/yrt���� 1333 S�n���i� dr. .San.�-��,.5 �r/��ti Sd'X'i�3s�-a/Z3 <br /> --�— <br /> �••A!:i nARil ADDRE55 GITV IIP PHOtJ[ <br /> l/aca.o P' _ <br /> ���CHRECT OH GEAGNEP NPIL NDDNF55 CItY Z�P PNOr1E <br /> �OnG <br /> •!f1[R4L CONTRACTpR /AAh ADORES$ CITY 9V PMQiE StpTE IICENSE r <br /> dfNr!!✓S <br /> Cf.CHn^aGALGONiMLTOF MMLAOORE55 LT' ZIP PNONE SIATELICENSE• <br /> t;iiMBMGCONTR�CTOA If.J11LADDRE55 CRY Z� PMA1E SiATELIGENSEt <br /> C'ANTRACTGRICEOFWOqN / _—� � <br /> ..3��� Y �j�) _.�\,� <br /> DESGPI9EWOfikFND50U4P iA _ . CON�,GH .: �N04(.WJ s�y-o��3Q s��3�,o,�y <br /> � <br /> �� �JixF /h �f�t !N � !/ir �- � GS3�3oSj1� <br /> � d���.�w,-, 319�0/��6 <br /> �U✓JVl1'�!d 71� /'GC•'� �JOTiJ�� O�t'(JYC� I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> r w�•os�_o se ur suu e�, a /��- ' APPLICATION AND KNOW THE SpME TO BE TfaUE AND CORRECT. AL� <br /> ���5� �( (/O'�/T� �P PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> irc�ai orccm=rior+,j i�:�nr��ay u�.owr�r,uowoa>rTnc��lvroco�ies WORK WILL BE COMPLETED WITH WHETHER DPEGFIED HEREIN CR <br /> i S�/. y v,yl��L�S y � C/��aA�y /.wy�C�p NOT. THE GRANTING OF A PERMIT DOES N�T PRESUIdE TO GIVE <br /> —�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF A�Jv <br /> � �/y1�� / )(� OTHER STA7E OR LOCAL V.W REGULAT�NG CONSTRUr,TiON OR 7f+[ <br /> '—''nG """-�T-�y--�«T�_���� ' PEfifORIdANCE OF CONSTRUCTION. THAT I AM AUTHURIZED BV THE <br /> OWNER OF T41S PROPERTV TO PERFORM THE WORK FOP WHICi+ <br /> -- - — APPL�CATION IS MADE AND I COMPLY WI'iH THF S'n1F <br /> rmc,�i v...i„ tunr�ci� CONTRACTORS LAW 1627 RCW AIJD 296200 WAC. <br /> _ _ y/_/3_-voa - 0/3 - nco7 <br /> • .;.�. ��. �'.%' ! d�JRE55.1[LEFHGNEHU4�:E�� <br /> /u°��L- X— - - /0-3" y 3 <br /> PROJECTADDRES pp�/ "'��{� / _ ""'� <br /> 3b�� � � �.e E��d �o d-= <br /> PLUMBMG MECH�NICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATEP CLOSE7 �TOILET) � A'C—A'HNDLG UNITS—H.P. � <br /> _ 6ATNTVO � FORCED AIR SYSTEMS—B.TU. M E.A. _ <br /> IAVATORV IWASH BASIN) UNIT HEATERS—B.T.U. M _ <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEIJ SINK 8 DISP VENTILA710N FAN � <br /> DISHWASHER f��NGE HOOD <br /> L�UND�i Y TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> _ —�- <br /> URRJAL ' METAL FIREPLACE(WOOD BURNINGI <br /> DRINKING FOUNTAIN FIflEPLACE INSFFT i <br /> -. — —_ � _ <br /> FLOOR DRA�tJ HEAT PUMP � <br /> 9ACKFLOW PFEVFNTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS �— EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.i ; _- <br /> — � <br /> � <br /> -�*— <br /> j <br /> SUB TOTAL $ i � SU8 TO7AL S __ <br /> PERMIT $ � PERMI7 S / � <br /> _ � TOTAL FEE "e � TOTAL FEE $ .,�J '���_ <br /> FOR OFFICE USE ONLY: _ <br /> �: .P�l tib/_��. REARuEiBRGM 51(JESETBACK �Ln���HCCNyIIAtfiC4i / ICI �rf�.El{�TIJU <br /> / <br /> � ::z�iar i.ornaen VACANTSRE FEES` VALUATION FEE <br /> �— <br /> :�, YEB ;�� NO puuomG <br /> --i— <br /> Pll'FOfLONEI. NO.OPSTOHIES (2CWAN[r MVn�[m'HWi4�hrt5 ---- — <br /> enou� p�UA�I�ING <br /> •�IEC�FBLDG FlqESPRINNLER5AE0'D BASEMENT Y ;:�,� <br /> � MLCHANICAL �r�y_ <br /> '� YES ��- ND -- <br /> �i rppqNCY IOAD fIPE ALPPM RE00 HEiGNT I�MrtAtiON AD'JITIONAL PLAN CHECK i � <br /> i I <br /> _ OTHER <br /> _ --'—.�— <br /> r4ECv — <br /> 51ATE BUILOING SURCHARGE <br /> � �,nr+snrr�nveoev CITYUFEVERETT PUBLICWORKS <br /> ! LOCALSALES T— <br /> ;,, TAX CO�E iS 3105 TOTAL <br />