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APPL6CATIOR�OR CONSTRUCTI�1 PERMIY � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT Er <br />BUILDING DEPARTMENT ' HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING }� SIGN <br />Na/ /9 _ <br />GENEflALCONTR/,CTOfI MAILAOOflESS CITY 21P PIiONE STATELICENSEk <br />�'[G� �1�iit <br />1B�ERMfICTLCONTRFCTOR MNLADDRESS CITY 21P PHONE STATELICENSEk <br />� , � � � <br />CITV ZIP PhIONE <br />%�/ /'T <br />CLASS F WORK <br />.I NEW ❑ ADDITION I_1 ALTERATION C I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT [-.I BUILDING RELOCATION <br />CONTACT PE(iSON AIJD PNONE NO. <br />rnurnn�roei�cne�unov .r L/ 114/i 12_..u. c/l lrla r...n.il <br />INVO�VED <br />LEGAL �ESCflIPTION OF PROPEOTY (SHOWN BF.LOW Ofl ATTACH FOUR COPIES) <br />LOT OLOCK OF <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWEfl <br />KITCHEN SINK 8 DISP <br />D�SHVJASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINY.ING FOUNTA�N <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEADERS <br />FOR OFFICE USE ONLY: <br />fRONTSETBACK f1EARSETOACN <br />USEZ�� IOTAREA <br />/ <br />SRE OF OLDG. <br />PEASON FOfl SPRINKLEflS <br />NO.OF STORIES <br />SU8 TOTAL $ ; <br />PERMIT $ —� <br />TOTAL FEE $ ' <br />SIOE SETBACN <br />V�CANTSITE <br />�un� acuv.wcr xo.mwrcuixauuns <br />LflWP <br />�ASEMENT <br />iflEO'D HEIGHTLIMITATION <br />INTAKEBY PLANSAPPROVEUDY CITYOFEVERETT <br />J�FI t0�11�94' TAXCOOE SL3105 <br />I HEflEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE Sl+.ME TO BE TRUE AND CORRECT. ALL . <br />PROVISIONS OF LAWS AND ORLINANCES GOVERNING THIS T!PE OF �`� <br />WORK WILL BE COMPLETED INITH WHGTHER SPECIFIED HEREIN OR � <br />NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 7HE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOAIZED.BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WtTH THE STATE <br />CONTRACTORS LAW iB.27 RCW AND 296200 WAC. <br />, .X _ ., 9-�9-9y <br />si nimie . oue <br />CRY �OSME55 LICENSElID <br />MECHANICAL <br />TYPE OF EQUIFMENT <br />AIC—A/HNDLG UNITS—H.P. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREPLACE & CHIMNEY <br />HEAT PUMP <br />GAS PIPING <br />PUN CHECK Nl1MBER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M E.A. <br />PERMIT $ <br />TOTAL FEE $ <br />FEE n� <br />//n i <br />FEE <br />GX <br />tl <br />' O <br />`h <br />