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� • � _. <br /> APPLICATIO�I FOR CONS�RUCT�ON PERMIT <br /> CITY OF EV RETT� BUILDI *DIVISION <br /> 3200 CEDAR STR�VERETT, WA 98201 •259-8810 <br /> fl DEMOLITION GY COMBINATION G7 BUILDING �NICAi R PLUMBING fl SIGN <br /> PROJECT ADDRESS � <br /> 2 (o b �V�t� <br /> OYMER MRILAODRE55 C�TY ZIP PNONE <br /> ���.� l��rr.H to3R�l �► Pc. NE ��m� t,� 9�izr ��z�91 <br /> TENPNT MAIIAD�P 55 LIIY ZIP {+IIONE <br /> ARLHITECTORDESIGNER MAILAUORESi GITY 71P PNONE <br /> GENERPLCONTRRGTOR MAILA�URE55 CI7Y 21P PHONE S1ATElICENSE• <br /> P�,c.�� �„1dtc,s, L,�� 5��... Pac►�6�o9ocM <br /> MECHANICALCONTRACiOR MAILADDRESS CITY ZIP PIIONE STATELICENSE� <br /> PWMBINGCONTRACTOR MnILADDRE55 Cltt Zm PHONE STATELICENSE� <br /> Pac�l,�., � <br /> CONTF�C PRICE OF WORR <br /> � �Vr HEATING SYSTEM: �l GAS FYELECTRIC fl <br /> DESCRIBE WORK ANO SOUARE FOOTAGE INVOLVED CONTACT FERSON N�PHONE NO <br /> �NaN �F —1��k9 <br /> I HEREBY CERTIFV THAT I HAVE READ AND EKAMINED TH�S <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROPOSEOUSE OF BUILDING PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T`rPE OF <br /> S.F. � WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORAifACHTWOCOP�ES) NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> h PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> D S �CLb � � �O APPLICATION IS NADE AND 1 COMPLY WITH THE STATE <br /> P�RCEL iNf ID.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> • <br /> CONSTRUCTONLO�NI.ENOER.�DDRESS,TELEPNONENUMBER x ( <br /> � SIGNATUF DAiE <br /> CITY BUSINE55 LICENSL . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) � A/C—AMNDLGUNITS—H.P. ' <br /> BATHTUB � FORCEDAIRSYSTEMS—B.T.U. M E.A. ; <br /> � LAVATORY(WASH BASIN) � HEAT PUMP � <br /> SHOWER ' UNITHEATERS—B.T.U. M � <br /> KITCHEN SINK 8 DISP i CLOTHES DRYERS i <br /> DISHWASHER � VENTILATION fAN � <br /> IAUNDRY TRAY ; RANGE HOOD ; <br /> CLOTHES WASHER � WATER HEATER <br /> � URINAL ' WOOD STOVE ' <br /> DRINKING FOUNTAIN i METAL FIREPLACE(WOOD BURNING) i <br /> FLOOR DRAIN � FIREPLACE INSERT(WOOD BURN�NG) � <br /> BACKFLOW PREVENTERS ; GAS FIREPLACE � <br /> SINK(SERVICE—BAR.ETC.) � GAS RANGE � <br /> ' GAS PIPING <br /> i EXHAUST FAN � <br /> � � <br /> 1 1 ... ..y. �. <br /> 1 � <br /> �. <br /> SUBTOTAL 5 ; SUBTOTAL 5 ; � . "� -'{�� <br /> PERMIT 5 � PERMIT 5 i � � <br /> � TOTAL FEE S � ���`E <br /> TOTAL FEE S ' � <br /> FOR OFFICE USE ONLY: �g`J. �I <br /> fRONTSETPALK REMSFTBACK SIDESEi�N/ PUNCIIECNNUM FEF RECEIPTNO <br /> � ' z6 � � 3 I/.3.i� <br /> useZor+�j _ / LOTPREA VACANTSITE FEES VALUATION FEE <br /> /� nvEs �� No emimr+c Lt3 Y9L �Otn � �%'C) <br /> HEIG11TLiM17AT10N/ NO.OFDWELLING 52EOFBLOGRI i <br /> UNIiS CWMOMG <br /> y63 SF BS.+ �� � p��� <br /> —�-- <br /> OCGOl1�ANCY NOO�SfORi[S OCCUPANTLORD BASEM� EN�T MECIIRNICAI � r� Lq,� <br /> .� WES II NO <br /> FIREALARMREO�D �F�SOY A�DIIIONPLPLANCHF.CK �L?�/� <br /> �—f'_ <br /> 0111ER � <br /> i <br /> 1'IPF.SP��NKLERREO'D REASON -- <br /> ST41E BUIIDMG SIIRCN�RGE i� <br /> tvvEorr,oNst rinNsarrnoveonv CITYOFEVERETT runur.wonKs ; <br /> �I �"}' LOCAL SALES �— <br /> �—�,/ „a,E �� � qS TAX CODE IS 3105 7o7aL 3 3 ' 7 <br />