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- APPLIGATIOI�FOR CONSTRUCTI�.N PERMIT �'°���'� <br /> . meeve�g.een TO BE COMPLETED IN INK—PLEFISE PRINT � <br /> CITV OF <br /> eve rett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ — � <br /> BUIIDING DEPARTMENT <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING �CAECHANICAL PLUMBING SIGN I <br /> �--�a pyyryEq MAiI nDOR[55 CIiY 2iP � PMUNE <br /> �' �,�1 , ' � l.ckelFr,� lny�l jl/;,,f /,Y+�� FvPre�f" 9St'1�� ' 3y7-�3:��' I <br /> ' IENPNT MAILpDORE55 ITY 21P PNONE i <br /> ARCHI*ECIOADESIG11Ef1 IAARRODRE55 GITV ZiP PIIONE <br /> C7 GENERALGONTRACTO1B /1 M1IAIL1A1DORE55 I ^ C�RV (� ZiP � �1 P�HOyNE� /y�1 ,IIICENSErI � �� /O \ <br /> yrpyC� 1�(�.� ����_��'lY� l'm��: ��(Co r) ��LILL_�1'4(�_( 1�.1["�5.�➢2L.1_L15'I-�r�-IA �l�Ll�\!l"S�.J_J�.� (��11�ZJ�I ' <br /> l•J�y IA[C�iANICAdCONiR4C�OR AIRILADDRE55 � CITY 2iP PNONE LIGENSE� <br /> C'�� FlUM01NGLONTRAGTOli �����D�RE55 GITV ZiP �IIONE IIGENSE� �'� <br /> 9HV+ <br /> � C1R550F1VORK <br /> NEW ADDITION xLTERFT10N � FEPAIR � DEMOLITION . . WOOOSTOV6FRPL INSERT BUILDING RELOCATION <br /> K y� � <br /> � N� /� • LONTACTPERSONAN�PHONEHO. <br /> CA�"� CONTRACTFRICEOFWORK'/�J� , `' � ' <br /> y .Z DESCRIBEWOPNANDSOl1AREFOOTRGEINVOWEO <br /> / . <br /> Oy� <br /> Pl10POSEDUSEOF011IlOiNG I HEREBY CERTIFY THAT 1 HAVE READ AND EXAM!NED THIS <br /> H �g SF� APPLICATION AND KNOW THE SAME TO BE T(iUE AND CORRECL ALL <br /> 4�� O LEGPLD[SCRIPTIONOFPROPERTVISHOWNBEIOWORRTTACMF011RCOPIES) PFOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WIIL BE COMPLETED WITN l4HETHER SPECIFIED HEREIN OR <br /> x y� �oT e�ocK oF NOT. THF GRANTING OF A PcRMIT DOES NOT PFlESUME TO GIVE <br /> � � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> H y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � V�H PERFORMANCE OF CUNSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> n d y OWNER OF THIS PROPERTY TO PERFORht THE WORK FOR WHICH <br /> C�' APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> .3i �� CONTRACTORS LAW 1827 RCW AND 29F200 WAC. <br /> s <br /> xyy SiGNATUREOFCONTRACTOFOPRUiNOHt2EDAGL11i OAi[ <br /> H O fn X 'f ( .,� . <br /> PR0.1[CiA�GRE55 • '-"����/ �//�L��`. — ' /—/�' � .�' <br /> �PPPLiCANiS CL�6USm¢n5 LiCENSE NO�ND BUSiNE.J++nde <br /> i:• — ��C�: _ � <br /> PLUMBING MECHANICAL <br /> i N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF[OUIPMENT FEE <br /> �,� WATER CLOSET(TOILET) h'C-NHNDLG UNITS-H.P. <br /> I= BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> � LAVATORY�WASH BASIN) UNIT HEATERS-B.T.U. M <br /> SHOWER � CLOTHES DRVERS <br /> ' '�� KITCHEN SINK&DISP VENTILATION FAN <br /> ! �� DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATER 1_ <br /> N �• CLOTHES WASHER � WOCD STOVE <br /> I I `� � URINAL i METAL FIREPLACE 8 CHIMNEV <br /> � <br /> I _ DRINKWG FOUNTAM � _ FIREPLACE INSERT <br /> I FLOOR DRAIN HEAT PUMP � <br /> � OACKFLOW PREVENTERS GAS PIPING <br /> "�'i ROOF DRAINS-RAINLEADERS EXHAUST FAN � <br /> '— — <br /> SINK(SERVICE-BAR.ETC.) <br /> '� <br /> i <br /> �� SUB TOTAL 5 SUB TOTAL 5 ?J ; - <br /> �+' � PERMIT $ PERMIT 5 /�- � - <br /> TOTALFEE 5 TO�ALFEE S ',�� <br /> , r FOR OFFICE USE ONLY: <br /> GPONTSEiOACK HERRS[ipACN SIpE5ET8AGN PIAhCnECMNllA1pER x F[E PECEIPTNO <br /> �r <br /> us�zorve iornAen VACANTS�TE FEES VALUATION FEE <br /> BUILDING <br /> hPLOfLONfSAIIOWABIE iVPFOiCONSi.ACiWI xNr�vcr rWpunuuxG��v.R <br /> 1PWo PLUMOING <br /> ::IlL OF OLDG ND.OF STOR�'c5 6�SEMENT MECHANICAL ylj 1 <br /> i <br /> CCCUPANGY LORO iIRE SPRNRlERS REO'D NEIGMT IIMIiAT10N ADDI110NAL PLAN CHECK <br /> OTHER <br /> HI�AtiON FOR SPAINKlERS � <br /> STATE DUILDING SURCHARGE <br /> �mn�rnr rur+snrrivovF.nuv CITYOFEVERETT PU�LICWORNS <br /> LOCRL SAlES � <br /> TAX COOE IS 3105 rorn� /�_-� — <br /> � <br />