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AP'PLICATIf�! FOR CONSTRUC7 m )N PERMIT �� <br /> TO BE COMPIETED IN BLACK INK—PLEASE PRINT <br /> BUILDING UEPARTMENT HEATWG SYSTEM: ;�GAS ,J ELECTRIC J _ _ ___ ___ 1 <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OtYtlER IdNLAD�.L55 CiIY 21P PHON[ <br /> y�IUC � ��Ycc� sov�Y i��5_ �sDG��rmo���i &Vdrt�err yr��a� 3v � -2 �s2`._ <br /> ICNnNt MAiL��DIiE55 CIiV 21P PHONE <br /> -� �t'12LL <br /> .:NCHIL[CTORDCSG�lCR M11AiL�DDR[55 CiIY ZiP PMONE <br /> ��� �Jy��-?UB�s:�T vo s s�nT��.Sr. S. iu�i�:P 9�?033 £37.P,=u 5 i� _ <br /> GCNEFALCOMRACTCR I.�AiLADDRE55 CrtV ]N' PHOt1E STATELICENSEa <br /> ay �9�1���NT. !�. y�,�y�S ,�2KU4n�D 98oS� �a2— iSUo �asuDErocrc�5_ <br /> �Q]J'.� M[OVJ:iCAICCflTRACiOR A�NLAD�RESS CIiY ZiP PNONE STATEUCENSEI <br /> >y vH, '�' sAin L� _ <br /> H 3 PLU6�Crt1GCCNTflACTOi AIAiLADDR[55 CIiY ZiP VNONE S�ATELICENSEr <br /> y �H <br /> K y� c�nss oF wo�K <br /> � H� NEW jf ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUIL�ING RELOCATION <br /> [/1 H �p!;LACT PERSON ANO PHONE NO <br /> xz3 � cc�i.ancrvAicEOFwoak J[�.(� � '1 Jy�O .�Ir�l �l1�NL`-� ��� -�!S%� <br /> t�� y�d �ESCRiBEWOFNANpSOUAREPOOTAGEINVOIV[D <br /> � A,pD/T�yy r� dxisTiNc� LI✓/NE.�/> <br /> � �g PROPOSEDUSEOF6Wl�ING i HEREBY CERTIFY THAT I HAVE READ AND ERAAIINED THIS <br /> 'n� n / C S G '� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ~ PROVISIONS OF LAWS AND ORDINhNCES GOVERNING THIS TVPE OF <br /> 7. �--1 LEGPLDESCRIPIiONOFPROP[RiVISHOPiN�El01Y0RAT1ACNfOURCCPiE51 <br /> 9 H WORK WILL BE COh1PLETED WITH `NHETHER SPEGFIED HEREIN OR <br /> t" N� �or 6 otocrc oF NOT. THE GRANTING OF A PER�d!T DOES NOT PRESUA7E TO GIVE <br /> gy AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> ry� �$TivvoD� L OTHER STATE OR LOCAL LA1N REGULATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CON;,TRUCTION.THAT I AM AUTHORI2ED BY THE <br /> �j �[rx� 77/E��OF flt'CCll�U�rD �N LrJ�� c] PU9T$ �V''NER OF THIS PROPERTY TO PERFORN THE WORK FOR WHICH <br /> z yN APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> y p y CONTpACTORS LAW 1827 RCW AND 296200 WAC. <br /> r33C.�� iOL �2LiCc��2D5 �r S�bila�hl5/1 <br /> C'r�t�NTy, w195L1_ldCL� T�� X �1� /•Z-g'�1 � <br /> I'„OJEQ AOCNESS �F ) � � <br /> �6i � cx�cN &��ti'� y lc�� — _�_ — <br /> PLUMBING MECHANICAL � <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPh1ENT FEE <br /> ' � WATERCLOSETITOILET� AC-AHNDLGUNITS-H.P. <br /> i'� BATHTUB FORCEDAIFSVSTE6IS-B.TU. Id E.A. <br /> LAVATORY�WASHBASIN� UNITHEATEfiS-B.TU. M11 <br /> o � SHOWER CLOTHES DRYERS <br /> !, KITCHE�SINK 8 DISP VENTILATION FAN <br /> DISHWASHER FiANGE HOOD <br /> LAUNDRYTRAV WATEP NEATER <br /> �� �' CIOTHES WASHER WOOD STOVE <br /> � "� URINAL ' METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUIJTAIN FIREPLACE INSERT <br /> '... .,�, FlOOR DRAIN HEAT PUMP <br /> ..:M� � BACKFLOWPFEVENTERS GASPIPING <br /> ROOF DRAINS-FAINLEADERS ExHAUST FAN <br /> SINK(SEFiVICE-BAR,ETC.� <br /> � — <br /> __ —� <br /> !,`,� SUBTOTAL 5 SUF3TOTAL 5 <br /> PERMIT 5 P`�RMIT 5 <br /> TOTALFEE S TOTALFEE 5 —T <br /> " FOR OFFICE USE ONLY: �MoK-. DE7E.�7'ot�Sf I Z l o UciC ;,1, 5 �' <br /> ii�UliSEi RCK BE�f15[iDACK SIOESET9ACN PIANCII[CNNUM1RICR F[�n PEf. iP1N0 ` <br /> P ` � � ��i c "�./.f."� L���V �/' <br /> ue,ezo torneen vnenNrsrte FEES VALUATION FEE <br /> ,I /� 0 � <br /> euaoiNc E�57� �C I C�I� <br /> Id•[OfLOt1t9ALlOWAOIC IYPFOiL0.8i.AC1UAl ttu�eNnr tauuv:ucx�*��5 � -----Y-- — <br /> _ . � p°-3 ( PLUM�ING _ _ <br /> SVG of nloc. NO Of SiOBi[S 0�5[A�eNr MECHANICAL <br /> 136 sr ' <br /> c:�c��cv onD FmESPIt KtERSAEOD MEIGNTLIMIiFTOl01� ADUIT;ONALPLANCi,E:K s;;1 j <br /> N �V SPRINNLE(i � <br /> NI:ASON FOR SPRiNNLERS ---- <br /> STATE BUILDING SURCHARGL ;C �'` <br /> itlIDKEOV rinnsnaanovEoov CITYOFEVERETT pU�UCWOFKS .--L--" � <br /> LOCALSALES <br /> F f Z TAX COOE IS 3105 TOTAL �,��� I , , -- <br />