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o�i�iolt <br /> APPLICATlO.. FOR CONSTRUCTC�.�N PERM14 � <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> nm Ecorq�rrn <br /> CITYOF --- 1 <br /> eve rett HEATING SYSTLM' � GAS ❑ELECTRIC J --___--- — I <br /> BLIILDING DEPARTMENT <br /> 259-Fi810 �LUMBING SIGN <br /> DEMOLITION COMBINATION BUILDING �1ECHANICAL <br /> PHONE <br /> y 0�'�I/lC�fly /' AIAIIADORL55 y (., C/�ILV1/ �1,a��� ��������D <br /> p�'q y �rNnN�r���( ���•�nooRF55 '��5�.��-r 1� 21P PHONE <br /> A W <br /> C y <br /> ARC��II[1CTGIi!�DG�SiGN[R M1INLA�ORE55 CITY ZIP PNON <br /> /�'II �/,T1J/1,�1.-rn1jI� (�IS 2(�p5 �D �_$L� . E � 'b�D� -G- .2 UR��EN4153L1 <br /> � VlAN-�- y�^^�`_`�''� ��r� Zi� r�+or+e LICENSCI <br /> K y p `;['�[Flp�NiPAQo� MAtLP00P[55 <br /> b N ro <br /> N p.� — CIiY 21P PHONE LIGENSE� <br /> � � �+ 6�[CnANiCALCONiRAGiOP AIAILAO�RE55 <br /> � PNONE LILENSE 1 <br /> O H PWANWGCJNiF�CTOF 1.1AILRDDRESS <br /> CiTY ZIP <br /> � � <br /> �-1 Q CL�55 OP 1VORK - <br /> y y E NEW AD�ITION ALTERATION . �''� REPAIR � - DEMOLITION . ! WOODSTOVE/FFPL INSERT BUILDING RELOCA I <br /> �� �; CONiACTPERSJNANDPHONENO. <br /> �y N H <br /> J, y �'�50.00 <br /> Y � y CONiRACT PRICE Oi'140f�N <br /> Cl <br /> � p � OESCRiOEWORNAN0F0U�'."OOTR�EINVOLVE <br /> �v �o'��¢�r and i,�at�X_f� <br /> H N I HEREBY CERTIFY THAT I HAVE REA� AND E%AMINED THIS <br /> O y; rnoroseousEOFeuaowc <br /> c� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE . <br /> �J PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROPERTY(SMOWNBElO\YORRTTPCHFOURCOPI[Si WORK WILL BE COMPLETED WITH WHETHER SPEpF1ED HEREIN OA <br /> �ot °LOC� °F AU�THORITYRTO VIOLA�TEAOR CANCEL THEOPROVESIONS OF AINV <br /> PERFORMANCEOOFOCONS RUCTION.THAT I AM AUTHORIZOED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SIGNAiUR[OFGONTRNCTOROR4UTMOPIZE�/GENT �N[ <br /> PRGECT AO�PF ppp i,pNiS Gi•�USIN.55 UCENSE N0.�55 NAM-�� <br /> f,.. .; � r, �1 ��.�-o-r o.,,.� <br /> � ��� PLUMBING MECHANICAL <br /> FEE NO. TYPE OF E�UIPMENT fEE <br /> . NO. TYPE OF FIXTURE OR ITEM qiC—A'HNDLG UNITS—H.P. <br /> 1 WATER CLOSET(TOILET) <br /> B�THTUB FORCED AIR S`.'STEh1S—B.T.U. M E.A. <br /> I� 1 LAVATORY(WASH BASIN) UNIT HEAT[FiS--B.T.U. M <br /> �� CLOTHES DRYERS <br /> SHOWER <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> �s� WATER HEAT[R <br /> i I_ 1 LAUNDRVTRAY = <br /> � CLOTHES WASHER WOOD STOVE <br /> � METAI FIREPLACE 8 CHIMNEY <br /> URINAL ; <br /> ORINKING FOUNTAIN i FIREPLACE INSERT <br /> � '=1 FLOOR DRAIN — HEAT PUMP — <br /> , BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> . SINK(SERVICE—BAR,ET0.) — <br /> , � <br /> �I�� <br /> � I � � <br /> SUB TOTAL 5 � ; �'- SLI�3 TOTAL 5 <br /> i�� PERMIT S _ PERMIT 5 <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: n�ceiPr r,o <br /> PIANGHEGNN0A10F.R (EE <br /> FPOM SEIBPCK REAR SETOACN tiiD[5[i��CK � � <br /> USE20NE LOT�RE� VACANTSrtE <br /> FEES VALUATION FEE <br /> BUIL�ING _i_— <br /> i!P(OLCONISAILOWABIE TYVfOftONSi.AGiW: ao,��•.cr xopmnunau•nis �—T _ <br /> �°��^ PLUtABING ` � <br /> �Tq <br /> S¢GOFBLUG. NO.OFSTORIF.S BRSEA'SNT MECHANIC4L �''LYJ__ <br /> OCGUPANGII��D FlRE:PBt�K�ltR3RLOD MEiGHTLIMITRTION <br /> AODITIONAL PLAN CHECK _ <br /> OTHER �— <br /> iSA50N fOH SPRiNHLLRS <br /> STAiE BUILDING SURCHARGE . <br /> mrnner,c Pi.�r+snrrnovenov CITYOFEVERETT PUBUCwOaKS . <br /> LOCALSALES <br /> TAX CODEIS 3105 TOTAL <br />