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APPLICATIf `I FOR CONSTRUCT"7N PERMIT � <br /> TC BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> ----- .-- - ------ - -- ----- -1 <br /> BUILDING DEPARTMENT HEAl1NG SYSTEM: �GAS U ELECTRIC ❑ <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION I I BUILDING DQ MECHANICAL I J PLUMBINO I_I SIGN <br /> ovttien Mnn nnrnirst-- --�i�v� ---z�r• rnoue <br /> Bt«l3.s���r_�pQ/F_o•gts-�a. EvEeZ€sT---9_s'_�o3 �-3�01 <br /> irnnnr I.I�II.MOI1f55 cnv �m rnoue <br /> nnr.m�ectonnesi�ucn r.�ni�noonrsc — --cnr----'---- ���•� r•uorie <br /> 6f.NEIi�LC011IlUCi011 A��II.ADflilf55 CIIY 711' �IIONF SINELICENSF./ • <br /> AI[C114NIf.�LCn11I11�f,iOf1 i.au.nnnnrac -------- rnv--------- �n,----�- r��a+r 5111fELICF.115FI <br /> SJEJOL��✓��G_Y—L1�_G_�rNA✓F_!t� _�CYNNWOOd_.�AO.'j6__7,�Pj�_�UEALESO�S.�_ <br /> PLUMPM6CMlIIUCIOR A1n11 401��iff•C f.IfY 71P 191011E SI�IFLICENSEI <br /> C(klIMCTPI710EOfWOfiN � <br /> SO lo O. O O . - -- <br /> OFSCRtl1E WOIiR M!b SOII��F.fpO1�CF 111VtNVFb CnII1�C1 PFI15017 nHD PI10f1E NO^- y <br /> _' " __ "—_—_ —A-O_G_����..SO/✓ <br /> Ar Ervr.i✓G_C_o�__✓�esi o•✓-- --- -----7_?_�-P_��s' <br /> I IiEf7E9Y CERTIFY TfIAT I HAVE HEAD AND E%AMINED 7HIS <br /> rnoroscouse or ounnn+o APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI.AV. <br /> PfiOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iean�oescmrtwr�orrnorrnrv�snrn»in[towonnttnr.n�v��cor�Fs� WORK WILL 9E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOL TIIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot mocK — or -- ----- -- AUIIIORI7V 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OIHER S1ATE OR LOCAL lAW RFGULATING CONSTRUC�ION OR THE <br /> -- --- PERfORMANCE OF CONSTRUCTION.THAT I AM AUTHOF712ED BV THE <br /> OWNFR QF THIS PROPERTV TO AERFORM THE WORK FOR WHICH <br /> , ___ .____— - APPUCAiIUN IS MADE AND I COMPLY WITH THE STATE <br /> rnncei tnx i n r+w.mm CONIRI1C10RS LAW 1827 RCW AND 296200 WAC. <br /> _—yy_�_�_- oa�—Qoo7— --� - <br /> cc»+s�m�ci�+ton�+i remen.ni�nnvcs.ir i r rmr+F ni iunrn <br /> /- 9-95 <br /> ----- --- - - ------ �.�. <br /> .,,,�;�,� <br /> PROJECTADDRESS �` ,__._�2CS_L--_ — --- <br /> O/ �ErT � r.n.iii�s�ns^,�m.n�a.r�� <br /> PLUMBIN6 MECHANICAL <br /> ►p, TYPE OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � _ NC-AiIINDLG UNITS-H.P. � <br /> ;— - <br /> BATIiIUB _ �__ / _ FORCEDAIf15Y5TEM5-B.T.U. M E.A. ; <br /> LAVAiORV(WASN BASIN) � UNIf HEATERS-B.LU. M _�_ <br /> — � CLOiHES DRVERS ' <br /> SHOWER '-- ---_ .- ' -- � <br /> HIICHEN SINK 6 DISP � _ _VENTILA710N FAN T_ <br /> DISIIWASHER ' RANGE HOOD _ ' <br /> -- 'IAUNDRV TRAY --- ',___ �__.�_ WNER f IEAIER �_ <br /> -- � WOODSTOVE � <br /> CIATHES WASHER _ . � <br /> '-- ---- - -�-- <br /> URINAI __j__ __ M[IALFIREPLACE(WOODBURNING) ; <br /> — "-- ' FIREPLACE INSERi �_ <br /> DRINKING FOUNIAIN � _._ _ -- <br /> FLOOR DRAIN ---- - - ---- --- -------'--'-- � IIEA1 PUMP ' <br /> BACKFLOW PflEVENTERS i 1_ GAS PIPING ___�_ <br /> ROOf DRAINS-RAINLEADEf1S � EXIIAU57 �AN ' <br /> � <br /> SINK(SERVICE--BAR.E1C.) � _-- ,— <br /> - —'-- -- -r— — -�---- � <br /> — � —,— <br /> -'— — --- � <br /> - , <br /> _ ;— <br /> — - -- - , <br /> — � — —� <br /> ----�-- -- - � <br /> _ � <br /> SUD TOIAL $ ; ____ SUB IOTAL S 7 ' <br /> `----- --- �-- - PEflMIT S � <br /> --- -- ----- PC-RMIT---a ---_� _ .- �---- ---- <br /> — fOTALFEE E ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> - -.---� ----- -- -- neeemiNo <br /> rn�+rsemncK nennseienck siursrinnrK rinncner.Hrrounrn �Er <br /> utF�aiF io�nnen vncnr+i�ut FEES VALUATION FEE <br /> I I 'IES I I PJO � <br /> pl lll Unl6 '— <br /> 1vrfD'C01151 NOOf510nIfG---' .rcMur. bnqrtNilnrinn�c - . . - -. . --___— __ _—_ � <br /> i <br /> �^^^' rtunnauir, :-- <br /> -- - ------ - � <br /> sn¢ormoa nnrsrnmeirnsnrob a^st�.�rm �,���iinNicnL ' <br /> I 1 YES I 1 NO . . -.-------- --- -'--- <br /> � <br /> —'--' AUDIIIOf1ALPl��lCII[CK � <br /> cer.urne�r,r iono nne ni niv.�nron n�am i n.mntron ---- <br /> � <br /> --�——'-- ---'----�-- OIIIER--'—.— —�-- ----r— <br /> nenwe+ -- ' <br /> SIAIE f1UILUIN(;SUf1C.HMGE � <br /> __—__.. ._' __ __ . <br /> ' —_—_'_'_ _ __ _—___'__—_ <br /> -___.____-- _—___ - i <br /> ni�nKenr nnu,nrrnrn�inn+ CITYOFEVERETT rumicwonKs i <br /> LOCAL SALES � <br /> ����. TAX COOE IS 3105 �oT�� � <br />