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APPLICLi'i'IC-�� FOR CONSTRI�CT� 1N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �/�T <br /> BUILDING DEPARTMENT HEATING SYST[A1_ J GAS �J ELECTRIC �] ��P _ l <br /> 259-8810 <br /> DEMOLITION COMBINATION �C BUILDING ' MECHANICAL I ; PLUMBING ! ; SIGN <br /> � c:,r:iv i�r.�.i.nC:r,css rirv �., rv--r.;_ '_ <br /> D�J'��?E'S 5%i� /Jt�/a wnve �✓c�re%JF 9E3ao 3 as.�. _ o,�. �y <br /> TENANI lAALLApGRE55 CiTV ZiP Vt�DI:E <br /> ARCMITECTORDESiGNEP MAILADpRE55 CITY ZIP PNONE <br /> ��DYt'SS�Q�s�rn_�,2Y/8 fq./..f r.-��'�z Ev2rPl/ 98.�0/ _� SJ 2d�o <br /> G[N{RALCONTRRCTOR MNILAD�flE55 Cltt 21P PHONE SiA7ELIGENSE� <br /> yC)H <br /> xr^� /Q09FY�Iirl [•'o.�s� �o.3�Y_3aiG Ev�`P1i 98ao3 337.��a1 RoErvocoaar.v <br /> �9H IA :��ANiCALCONTR4GTOF MRILADDRESS CITY ➢P PMJNE STATEUCENSEI <br /> C�H <br /> ,y� PWIdBiNGCONTRACTOR M4RADORESS CIiY ZIP PHONE STATELICENSE• <br /> rx <br /> H a� <br /> � z� CONTRACT PflICE OF WOFK L/�� �_ <br /> y� G t� <br /> DESLRIp[\VORNANOSOURREFpOT�.GEINVOLVEO � / CGNiACTPER50NANDPMONENO � <br /> yy� =�i,Q �l�i ct�,� � f�oOPv ���r� 3 37_ 7G 1,� <br /> � O ti1 �4�N 4 <br /> Hl7 <br /> Hey-� �t�P � i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> CT]CJ PROPOSEDUSEOFBUiIDiNG APPLICATION AND KNOVJ THE SAME TO BE TRUE AND CORRECi ALL <br /> �` nq Qy� PROVISIONS OF LAWS AND ORDINANCES GOVERNINt3 THIS NPE OF <br /> xH 3 �ecnio �caian�+oFvaoveanisNowrvee�oweaanna�Twocowesi WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> a y�'� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> r F„�y �or-9L— eiocK ✓`O cJ oF F/o v��..�a., J` ff7 S <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �' � OTHEP STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ~ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> C� C(!� <br /> c:� C,� — — OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � ��� APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> t FApCELTAX G NUAIBER � <br /> z y y CONTRACTORS LAW 1827 RCW ARD 296200 WAC. <br /> HOcn yid� _oe� _ � / _ DOO <br /> CONSTRUCTiONIOANLENDEfi.rtO[`RCSS �FLCf��ONE1lUYP.C� <br /> �/I q <br /> �j'//'2 .Or'/�J&'il✓�_EC_✓_L�✓�Tl`. � -'?/JY-v.__ _ �=S=<-.� <br /> PflOJECT A�DRESS ��+-,..� oe�c <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO, TYPE OF EOUIPMENT FEE <br /> r � <br /> VVATER CLOSET ITOILETI � A C—A�HNDLG UNITS—H.P. <br /> �= BATHTUB __ __ PORC[D AIF SVSTEMS—B.T.U. M E.A. <br /> LAVATORY IWASH BASIN) UNIT HEATERS—B.T.U. M <br /> — _—� <br /> SHOWER CLOTHESDRYER;. <br /> p�" v KITCHEN SINK 8 OISP VENTILATION FAN <br /> �* � DISHWASHER RANGE HO00 <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES WASHER 1V00DSTOVE <br /> I� ' URIN�L MET�L FIREPLACE(WOOD BURNING) <br /> �� DRINKING FOUNTAIN FIREPLACE INSERT i <br /> FLOOR�RI11N HEAT PUMP <br /> e�o�' BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS �— ExHAUST FAN --� <br /> SINK(SERVICE—BAR,ETC.) ' <br /> o ��—� --— _ <br /> —— — ;--- <br /> `� SUB TOTAL 5 SUB 70TAL S <br /> 'i'� PERMIT 5 PERMIT $ <br /> TOTALFEE S TOTALFEE S �— <br /> , FOR OFFICE USE ONLY: �uv_I_�'_ SIyJ � Pc i�c-To�S I��� �1 u' G ,) . �� <br /> rnorvtsEroJK� ncansiton�� sioEs�r�ncK i�in���icK��r.�qkn rr� C 2�; neceiP i � <br /> Z Zo ,5 ` � <br /> use� �ornNEn VACANi51TE FEES VALUATION FEE <br /> � �I � 9�� C� ;-' YES i� NO OUILDn�.� _�ti <br /> iYPEOfCONSt NO.O�SiO�iiCS etturav�. xaomqurcc.ns -- ��1 ��� ���� ; �✓ <br /> Tl_N I �A� I PLU1.7�ING ' <br /> Y �_ ' <br /> SREOFOLDc. FiNEsrnwrc�[nStaEOo On5[MEN7 MECHANICAL <br /> SZS Sf G4a 0 �'� YES x NO , <br /> OCCUPAHCYLOAD fIREAIARhIREOD NEIGt/iLIMITAyl10N ADDITIONALPLANCHECK � �J <br /> ZC�/ OTHER <br /> REASON — -- <br /> STATE UUILOING SUHCHAflGE <br /> � �, <br /> iNmKeov cinNsnrrv�oveonr CITYOFEVERETT Nuoucwof�Ks � <br /> �/� LOCAL SALES � ` <br /> °''"` 3�/u�`T 3 TAX CODE IS 3105 rorni �, Z � ��� <br />