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APPLICATIQ 1 FOR CONSTRUCTi )N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: XGAS ❑ ELECTRIC J <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION BUILDING ❑MECHANICAL �LUMBIN3_ I I SIGN <br />OWNER L•ALDRESS ADcm YID PHONE <br />RicDeT WesT C(SnR. 3l8 5' EU2ra VN»II wv 48LOB 290.4(PQ(Q Puaerl & V -1 K� <br />GEHERALCpIriUCtOR ADDRESS 4TTV LP PNONE !CkEE <br />N/A <br />PNCNE STATE LCERMI <br />GGL OUbJ 1— l LC\Sa UIWDIA< bG1 ! WATLY DL• ewe q YO l.VJ ��7-aoYL <br />1\ ftumll OCONIRAOTON MAEADMESS Cm Z" PHONE STATELICENSEr <br />11 `` 31 20, Orin <br />CONTRACT PRICE Of WORN <br />-W 298E 5F- of Flax- Seo,A <br />v s <br />DESCRIBE WONT ANq �pwnE FOOTAGE INVOLVED <br />t FicR. <br />roots <br />COMACT PEPSON AND PNONE NC <br />pi\V2.. h1'4kL7CyuE'.M.IE� <br />, -r K P-- 5t, Gr RII <br />EVIr" <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED 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 1 ROW AND 296.20D WAD. <br />x (a/3a/93 <br />PROFbSEO us <br />5) <br />LEGAL DESCRIK"I OF PR EIM (SHONNULM rrAcxTVAwPEsI <br />LOT— BLocA oP <br />aARCELTAZ I.D. NLKIBER <br />q I _ ( �q 2 <br />CpIS1RUCTgN LOAN LENDER, AOdVESS 1 ELEPHgiE N W BE R <br />ao sr, SLIeflew MAIL 6V . 'e <br />PROJECT ADDRESS <br />crosuvcmLCErsE <br />xD <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OFFIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AG-- MNDLG UNITS—H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. MEAL <br />LAVATORY GNASH BASIN) <br />I <br />UNRHEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />I <br />LAUNDRYTRAY <br />i <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />I <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />13ACKFLOW PREVENTENS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN_ <br />SINK (SERVICE—BAR•ETC.) <br />, <br />SUBTOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $1 <br />1 <br />PERMIT $ <br />TOTAL FEE $1 <br />311 <br />1 <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />PRartBETBACKW�VAC�. <br />L{mE BEfBACK <br />PLANOHECI(NUDP3 <br />H/1F/EES <br />.5�JS <br />--I❑YES <br />VACu.V E <br />ONO <br />VALUATION <br />FEE <br />BUILDING7:(/�rroEmcm. <br />PLUMBINGSQEOi <br />amrNA. nvv.•.ucrP2 ,l'r <br />BIDO.E0D <br />2 2 . T <br />O TES :°iE NOHEKIHILAHA:rW <br />MECHANICAL <br />ADDITKPLALPLANCHECK <br />OTHER <br />REAsoN <br />STATE BUILDING SURCHARGE <br />LID <br />ATrw" <br />PLANS wrovEDBY CITY OFEVERETT <br />V LOCAL SALES <br />DATe ,7 TAX CODE IS 3105 <br />PUDUCwoRKS <br />TOTAL _ <br />i <br />