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; <br /> APPLICATIO�FOR f�ONSTRUCTI.,N PERMlT ���� ' �:F <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> IHEATING SYSTEM�GAS ❑ELECTRIC U —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> � � p�yryEq`� ,�/ MAiLA00RE55 CITV �u ZIP PHONE <br /> . i/��¢ l7d� �j• ��r �7)d I�'ICt4�rt.��e L✓�:rl� �/U -'G� <br /> TENRNT M�ILADORE55 Ci7Y ZiP PNONE <br /> ��� RRLNrtECT OR DESIGNER MA�L RODRE55 GITV 21P PIIONE <br /> q � GENERALCONiBACTOR NCiLA�DFE55 GTV ZIP PMONE STATELICENSE� <br /> y „ . , -,d �S'-E �uE�P�77 GJ-� C}U�oS �3%�595� /��.:,Sc�C/S�/K�°I <br /> y�� .�v5 s��� C.�,.S i' C� / i + �W <br /> MECMANICALCONTPACTOR M�ILAD�RESS Gltt ZIP PHONE SiATEUCENSC� <br /> N o �� � <br /> (��� PWMBINGCONTRACTOR AINLRDDRE55 CITY ZIP PHONE STAiELICENSC <br /> W M <br /> W <br /> � CLl�SS OF 1VONH <br /> O � NEW ��. ' ADDITION �': ALTERATION �. REPAIR �. DEMOLITION �WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> H CONtACT PEPSON AND PHONE NO 7 ['� <br /> � / T 3' Y-3 s , <br /> Q��JY[y CONiNACTPPICEOFWORN ��� o� /(�SSSII /�.�t(,/IO �FJG -L�,✓.1.. r <br /> lgg] DESCRIpF WOPN FNO 50UA�R7E F00TAGE INVOLVEO � <br /> �M� �4� �^.• �u• �•s (oe-:7 o,•Y/aT YL� G+a� . t ... <br /> y PBOPOS[DUSEOFBWIDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> M, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT.ALL <br /> ��..� LEGALDESCfiiPiIONOFPROPERtt�SNOWNBELOW ORATT�CH FOt1RCOP�ES� PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> u� WORK WILL BE COMPLETED WITH WHETHER SPcCIFIED HEREIN OR <br /> R �or o�ocn oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �� AUTHORITV TO VIOLATE OR CANCEL THE FROVISIONS OF ANV <br /> OTH=R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.TH�T I AM AUTNORIZED BY THE <br /> - � - � OWNER Of THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br /> X ✓C— (`.�� `D �/—� '3Z <br /> S C•:LIU0.L O�tE <br /> PF0.IECT AODRE55 ,/ — <br /> ��U ���we6^'C .y�v� arvoas�r.�ssiictr:scrvo <br /> PLUMBING MECHANICAL <br /> /- • NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> I ��� WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � � , LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYERS <br /> � ��� KITCHEN SINK 8 DISP VENTILATION FAN <br /> �' DISHWASHER RANGEHOOD <br /> � � LAUNDFY TFAY WATER HEATER � i <br /> � CLOTHES WASHER WOOD STOVE � <br /> � '�� URINAL METAL FIREPLACE&CH�MNEY I <br /> I ��' DRINKING FOUNTAIN FIREPLACE INSERT , <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING __� <br /> ` � fl00F CRAINS—RAINLEADERS E%HAUST FAN <br /> �� !1� SINK(SERVICE—DAR,ETC.) <br /> —� <br /> II 1������ , <br /> SUBTOTAL 5 SUBTOTAL 5 /�o ' <br /> � PEPMIT S PERMIT $ /S� <br /> � TOTALFEE S TOTAIFEE 5 _�� ' <br /> ��' FOR OFFICE USE ONLY: <br /> PRON�SETBACK RERRSETI3ACN 51][SETB�GN Pl�NC1ECKNUhIpEfi FEE N[CCIPTNO <br /> 3�D�� 'I <br /> USE20NE IOTARER VAC/NTSITE FEES VALUATION FEE <br /> DUILDIIvu <br /> t1PE0FGONiS.AILOWA6tE 7YCEOFCONSi.ACiUAI a[uru;;.r u0aow[ue.cu'.n� <br /> cAour ' p�UMBING <br /> $REOFBLD(3. NO.OFSTOF�ES BTSEMEN7 MECHANICAL � <br /> OCGUPANCYLORD FIflESPRNN�EFi5�E0D HEIGHTLIMITr1T10N �DDITIONALPLANCHECK <br /> SPRINKLER ' <br /> R[ASON FOR SPRINKLERS <br /> STATE�UILDING SURCHARGE . <br /> WIDKEBV PLANSAPPROVEDflv CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> TAX COUEIS 3105 TO7AL , <br />