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APPLICATIQ"' FOR CONSTRUCT�`�N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �E'T <br /> — - ------ --- <br /> rHEATING SYSTEM: 'J GAS J ELECTRIC J __._ _ _ _ __ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL ! PLUMBING SIGN <br /> OY:NER 61A�LA�DFE55 uJ Cirv .�, PHJqE � <br /> 1' �o�o Toow�,la� I �a�`{ ,(.'.G. 1�- �� �,.',l�P Zcrr. 9&a�a �2�) '`183-8�7� <br /> IENANT I.IARA�ORE55 CIiV ZIP � PNON[ <br /> ARCHIiECTOROESiGNEP 1dAiLApDRE55 CITY ZIP PMONE <br /> GFNER4LCONiPACiOR MAILPOORESS C17Y ZIP PHONE ST�iEUCENSE• ,:''i-�- <br /> s_;.., <br /> � u i!- 4NiCACd1TflAC10F IdAILAD�RE55 CITY ZIP PHONE STAiELIC[NSE� _.. . _-_ ... . .w <br /> p � � ,�'�ato`lCo�m1� <br /> � PLUI.�BINGCONTR�CTOP M1IAILRODRE55 CITY 2iP PNONE SiAtELiCENSE� <br /> .�y y y CCNTR�CT PRILE OF WOFK <br /> K � (� �ESGRi6EW0�NANO50UAR[FOOTAGEINVOLYED CONTACTPEFSONAh'JPNONENO. <br /> H �f <br /> '� H � <br /> [p M <br /> � O � � ex 1 HEREBY CERTIFV THAT I HAVE REA� AND EXAMINED THIS <br /> y anoroseo use uF e ii iNc �] APPLICATION AND KNOW THE SAME TO B[TRUE AND CORRECT.ALL <br /> O ~ X1/ 3�os�a ���cA 17J�' . �U�'e' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> Q�� `Lecn�oescniPnoNOFanoaeRTvis�wwn . wonn.ucNnvococi[s� WORK WILL BE COMPIETED WI7H WHETHER SPEGFIED HEREIN OR <br /> �„� NOT. THE GRANTING OF A PERMIT DOES NOT PRESU+AE TO GIVE <br /> 7,+ y � �or etacK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> C OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> H y PERFORAIANCE OF CONSTRUCTION.THAT I Aht AUTHORIZED BY THE <br /> g y OWNER OF THIS PROPERTY TO PERFOR�7 THE WORK FOR WHICH <br /> N <br /> ��y APPLICATION IS MAGE AND I COMPLY WIiH THE STATE <br /> PAFCEL TAX 1 D.NUMBEfl CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> F] � CONSTPUC7iON LOAN LENDER.ApDRESS.TEIEPMONE NUMIIER <br /> O �n X���¢� /U-S-�'i3 <br /> PFiOJECTADDRESS ""'""��'� �' a+�E <br /> �..�.r,-.�. >.,� �..�•. ,. <br /> PLUM9ING MECH�NICAL <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EdUIPMENT FEE <br /> ��� WATER CLOSET(TOILET) A C—A HNDLG UNITS—H.P. <br /> � �� — FORCED AIR SYSTEMS—B.T.U. M E.A. --�— <br /> BATHTUB <br /> LAVATORV�WASHBASW� UNITHEATERS—B.TU. h1 <br /> � SHOWER CLOTHES DRYERS --T— <br /> , KITCHEN SINK 8�ISP VENTILATION FAN <br /> ' � `_! DISHbVASHER RANGEHOOD — <br /> L_3i LAUNDflY TRAY WATEfl HEATEi i <br /> CLOTHES WASHER WOOD STOVE <br /> � URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ <br /> � �_� FLOOR DRAIN HEAT PUMP <br /> � OACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> �_ SINK�SERVICE—BAR,ETC.) � <br /> � �.,�1 J— ��� _�— <br /> SUB TOTAL S ' SUB TOTAL 5 <br /> �� PERA4iT 5 � PERMIT S <br /> � � TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> 1'RD�ITSCTBACK FEARSEiBALK SI�ESEI�TCN PUNC��[CKW1,1f3ER «G. RELCiPTNO <br /> �-�ZZ� <br /> usezoNe �otnnen VACANi511E FEES VALUATION FE�_ <br /> : YES . � NO BUILOP�G <br /> IYCEOiCOH51 NOAFSi00IC5 �u��'�cr �Aorrnur.:.�..•s — -- - — <br /> G°'`° PLUh78W(9 <br /> S�ZEOF9lOG. FiRESPRINKLERSREQD BRSEM[Nt MECHANICAL <br /> ": VES NO - <br /> OCWPANCYLOAD FIREAl�R61REOD NEiGMiL'h11TqTiON A�DITIONALPLANCHECH <br /> OTHER <br /> ivEnsou — <br /> STAT[�UILOING SURCHARGE' <br /> �mi.+�eev v�nr+snrrr�ovcoev CITYOFEVERETT aueuCwoaKs • <br /> LOCAI SALES — <br /> ,.,,,, TAX COOE IS 3105 TOTFL <br />